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11/56. Diagnostic approach and management of occupational asthma by persulfate salts in a hairdresser.

    An 18-year-old female hairdresser, nonsmoker and nonatopic, developed rhinoconjunctivitis followed by asthma after working for 18 months. The methods that were necessary to obtain a definitive diagnosis of occupational asthma are explained, as well as the medical management performed to improve her asthma over the next 12 months. Tryptase and eosinophil cationic protein (ECP) were determined before and after specific bronchial challenge. The application of these parameters as complementary diagnostic methods in some cases of occupational asthma is described. Clinical and functional control performed some months later demonstrated an increase in nonspecific bronchial responsiveness after avoidance, likely related to an upper respiratory infection.
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keywords = asthma
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12/56. A case of anaphylaxis due to rose pollen ingestion.

    BACKGROUND: Recent publications have demonstrated that in Guneykent (turkey), a rose-cultivating area, some workers experience various allergic reactions due to contact with rose or its pollen. CASE REPORT: A 47-year-old man, originally from Guneykent although he no longer lived there, suffered perennial rhinitis, asthma and rhinoconjunctivitis in spring related to sensitization to dust mites and various pollens, respectively. On several occasions, he had presented oral and cutaneous symptoms and angioedema due to contact with rose or intake of honey or other products. Finally, he had an anaphylactic reaction on drinking dew collected in the tulips of a rose that possibly contained rose pollen. methods: Specific IgE was evaluated with rosa rugosa extract and was 30.3 IU (class IV). Sensitization to other pollens and to mites was also confirmed. Oral provocation test was not deemed ethical. CONCLUSION: This may be the first reported case of anaphylactic reaction due to rose pollen ingestion.
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ranking = 0.125
keywords = asthma
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13/56. All that drains is not infectious otorrhea.

    It has been said that, 'All that wheezes is not asthma.' Thus, is also so of otorrhea. Bacterial infection most often causes otorrhea which, in turn, generally responds to treatment with ototopical antimicrobial therapy. When it persists, non-infectious etiologies must be considered. Although allergic causes of otorrhea have been described in the literature, inhalant environmental allergens (Type I Allergy) causing eustachian tube dysfunction or ototopical drops, most notoriously neomycin containing formulations, causing contact dermatitis are those usually mentioned. Further, most reports of contact allergic reactions of the ear have involved the external auditory canal skin or pinna and have been attributed to non-medicinal triggers like shampoos and metals used in ear rings. A search of the literature failed to reveal a reported case of recurrent or chronic otorrhea without cholesteatoma due to an allergic reaction to the components of a tympanotomy tube (TT). Such a case is presented here.
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ranking = 0.125
keywords = asthma
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14/56. Immediate-type hypersensitivity reaction to ingestion of mycoprotein (Quorn) in a patient allergic to molds caused by acidic ribosomal protein P2.

    BACKGROUND: Quorn is the brand name for a line of foods made with so-called "mycoprotein," which springs from the mold fusarium venenatum. Since the introduction on the food market, there have been complaints from consumers reporting adverse gastrointestinal reactions after ingestion of mycoprotein. To date, it is not clear whether the reported symptoms are IgE-mediated. OBJECTIVE: The aim of the study was to describe for the first time a case history of an asthmatic patient with severe hypersensitivity reactions to ingested mycoprotein and to identify and characterize the potential allergen that might be responsible for this. methods: The sensitization pattern of the asthmatic subject was characterized, and food allergy to mycoprotein was assessed by double-blinded placebo-controlled food challenge. Afterward, specific IgE antibodies of the serum of this patient were used to screen a fusarium culmorum cDNA expression library. The coding sequence of one enriched cDNA-clone was expressed in escherichia coli to produce a recombinant protein that was further purified and immunologically characterized. RESULTS: The patient showed high sensitization to many known aeroallergens but apart from Quorn not to any other tested food samples. The deduced amino acid sequence of the enriched cDNA-clone (Fus c 1) showed large identity to the 60S acidic ribosomal protein P2 which is highly conserved among several species and also described as minor allergen in other mold species. The frequency of IgE reactivity of sera from F culmorum -sensitized subjects to rFus c 1 was approximately 35%. By enzyme allergosorbent test inhibition, we found 65% inhibition of mycoprotein IgE reactivity by rFus c 1. On the opposite we found reduced IgE reactivity of rFus c 1 of 68% by using mycoprotein as inhibitor. CONCLUSIONS: Sensitization to mold allergens by the respiratory tract and subsequent oral ingestion of cross-reactive proteins may lead to severe food-allergic reactions. Thus, the 60S acidic ribosomal protein P2 of F venenatum probably is the reason for the described severe hypersensitivity reactions of the patient to Quorn-mycoprotein because of its potential cross-reactivity to the F culmorum allergen Fus c 1.
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ranking = 0.25
keywords = asthma
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15/56. Occupational rhinitis and bronchial asthma due to artichoke (cynara scolymus).

    BACKGROUND: The artichoke is a perennial horticultural plant that belongs to the Compositae family. OBJECTIVE: To present case studies of 2 vegetable warehouse workers who developed occupational rhinitis and bronchial asthma by sensitization to artichoke. methods: skin prick tests with common inhalants and foods were performed. Specific IgE to artichoke, parietaria judaica pollen, and olea europaea pollen extracts was measured by a specific IgE enzyme immunosorbent assay kit. Molecular mass of the allergens was studied by the sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) immunoblotting technique. patients underwent a nasal challenge test, and one patient provided peak expiratory flow rate (PEFR) measurements in her workplace. RESULTS: In both patients, results of skin prick tests to artichoke were positive. Levels of specific IgE for artichoke were 0.68 kU/L in patient 1 and 2.14 kU/L in patient 2. The protein composition of the artichoke extract, studied by SDS-PAGE, showed that most bands ranged from 30 to 14 kDa. The IgE-binding bands with the serum samples of patient 1 showed apparent molecular masses of 56, 48, 38, 31, 27, 25, 16, and 15 kDa; however, the serum samples of patient 2 showed IgE bands of 21 and 19 kDa. Western blotting of artichoke extract showed a complete inhibition of IgE-binding bands when serum samples were preincubated with P. judaica pollen extract. Nasal challenge with artichoke extract triggered a peak nasal inspiratory flow decrease of 81% and 85% in patient 1 and patient 2, respectively. Finally, patient 1 recorded a PEFR decrease of up to 36% after exposure to artichoke in her workplace. CONCLUSIONS: SDS-PAGE immunoblotting inhibition performed for the artichoke extract showed a total disappearance of the specific IgE binding bands when serum samples were previously incubated with P. judaica pollen extract, thus establishing the existence of a serologic cross-reactivity between artichoke and P. judaica pollen.
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ranking = 0.625
keywords = asthma
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16/56. Non-occupational allergy caused by the pine processionary caterpillar (Thaumetopoea pityocampa).

    Contact with the pine processionary caterpillar induces dermatitis, usually located in exposed areas, and, less frequently, ocular lesions through a toxic-irritative mechanism. Recently, the existence of an immediate hypersensitivity mechanism has been demonstrated, mainly in occupationally exposed patients. OBJECTIVE: To present four patients who experienced allergic reactions (urticaria-angioedema and rhinitis-asthma) after non-occupational exposure to pine processionary caterpillar. patients AND methods: The four patients underwent allergy testing through skin prick tests (SPT), specific IgE detection and SDS-PAGE immunoblotting. One patient also underwent a specific bronchial challenge test with the pine processionary antigen. RESULTS: In all patients, both SPT with the caterpillar extract and specific IgE were positive. Western blotting showed several IgE-binding bands with molecular mass values ranging from 18 to 107 kDa. A shift in the electrophoretic mobility of some of the relevant allergens occurred under the presence of a reductive agent (beta -mercaptoethanol). The specific bronchial challenge test with pine processionary antigen performed in one of the patients also produced positive results. CONCLUSIONS: The results of this study show an immunologic IgE-mediated immediate hypersensitivity mechanism in these reactions. The processionary caterpillar's airborne urticating hairs or spicules should be considered, at least in some locations, not only as contact and occupational allergens, but also as seasonal aeroallergens.
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ranking = 0.125
keywords = asthma
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17/56. Airborne allergy to sunflower seed.

    BACKGROUND: There is increasing evidence that bird fanciers may develop airborne allergies to unusual allergens. OBJECTIVE: To detect the allergen source in a bird fancier with a history of asthma associated with bird cage cleaning activities and with contact with a brazil parrot. methods: SPT with a large series of both airborne and food allergens were carried out. IgE reactivity to allergens causing wheal and flare reactions was confirmed by in-vitro investigations including ELISA/ELISA inhibition and immunoblot analysis. RESULTS: Strong skin reactivity to sunflower seed was observed. Immunoblot analysis showed IgE reactivity to low m.w. proteins, most probably 2S albumin, and ELISA inhibition studies showed the absence of cross-reactivity to mustard. CONCLUSION: Sunflower seed dust may sensitize patients via the respiratory tract. Differently from previously reported cases of sunflower seed allergy, no cross-reactivity to 2S albumin from botanically unrelated seeds was found.
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ranking = 0.125
keywords = asthma
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18/56. Omalizumab: a future innovation for treatment of severe ocular allergy?

    Conjunctival and corneal manifestations of atopic keratoconjunctivitis (AKC) are chronic, disabling and may be blinding. In common with other allergic diseases, such as asthma and atopic dermatitis, AKC is characterised by an allergen-induced immune response mediated through expression of IgE. The humanised monoclonal IgE antibody Xolair (omalizumab) complexes with free circulating IgE, thereby preventing binding of IgE to FcepsilonRI receptors on immune cells. Omalizumab effectively alleviates the signs and symptoms of asthma. Given the pivotal role of IgE in the allergic cascade, it is hypothesised that omalizumab has potential as an entirely new therapeutic approach to AKC.
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ranking = 0.25
keywords = asthma
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19/56. Occupational rhinoconjunctivitis and asthma by exposure to lathyrus sativus flour.

    We report the case of a 42-year-old non-smoking man, who had worked as a carpenter for 6 years and who reported a history of rhinorrhea, paroxysmal sneezing, nasocular pruritus, lacrimation, wheezing and dyspnea attacks while preparing a mixture to seal the junctures between wooden panels. Allergy study consisted of skin prick testing (SPT) to inhalants, foods and lathyrus sativus flour (LSF) extract, specific bronchial provocation test with LSF extract, cytological analysis of sputum, specific IgE antibodies against LSF, and histamine releasing test with dilutions (1:5, 1:25, 1:125, 1:625) of LSF. The results demonstrated occupational rhinoconjunctivitis and asthma due to LSF exposure. We provide a review of published reports to date.
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ranking = 0.625
keywords = asthma
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20/56. 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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ranking = 0.25
keywords = asthma
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