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11/48. 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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12/48. Bullous allergic hypersensitivity to bed bug bites mediated by IgE against salivary nitrophorin.

    In Central europe, bites from the common bed bug (Cimex lectularius) are nowadays rather uncommon. Nevertheless, infestations are sometimes observed in old framehouses and by immigration due to international travel and migration. The clinical picture of bug bites substantially varies between individuals, depending upon previous exposure and the degree of an immune response. The host immune response and potential protein antigens present in the saliva of C. lectularius or specific antibodies have not been characterized thus far. We describe a patient with bullous bite reactions after sequential contact with C. lectularius over a period of 1 year. In skin tests, we observed immediate reactions to the salivary gland solution of C. lectularius, which were followed by a pronounced partially blistering late-phase response. Immunoblot analysis of the patient's serum with salivary gland extracts and recombinant C. lectularius saliva proteins revealed specific IgE antibodies against the 32 kDa C. lectularius nitrophorin, but not to 37 kDa C. lectularius apyrase. Our data demonstrate that bullous cimicosis may be the late-phase response of an allergic IgE-mediated hypersensitivity to C. lectularius nitrophorin.
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13/48. Sensitization to horse allergens without apparent exposure to horse. Report of two cases.

    It has been well established that occupational exposure to horses increases the risk of allergic sensitization to horse hair, on the contrary very few data have been published in individuals without direct contact with horses. We describe two cases of severe respiratory symptoms triggered by a single direct exposure in two patients with only 4-5 previous short contacts with horses during the entire their life, since they live in urban area of Naples. Cutaneous and serological diagnostic tests showed significant sensitization to horse dander other than some common inhalant allergens. Our report suggests that, in already (but unaware) horse-sensitized patients, the last direct contact with a horse has triggered severe respiratory symptoms. Passive carriage of horse allergen by the clothes of individuals in contact with horses/horse environments or a cross-reactivity between horse allergen (a lipocalin) and the major allergens (also lipocalins) of several furred animals are likely to explain our findings. Some other considerations can be derived by the clinical observation. First, it is likely that allergic sensitization to horse allergens could be more frequent than expected also in subjects without direct exposure to horse because of living in urban areas. Secondly, individuals suspected to be highly atopic or those already sensitized to some pet dander should be tested by SPTs/radio-allergo-sorbent test before the introduction of a pet indoors or, in the case of a big animal as the horse, a direct horse contact/entering into environments containing a horse.
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ranking = 30.499576280875
keywords = occupational exposure, exposure
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14/48. Immediate hypersensitivity to rifampicin in 3 patients: diagnostic procedures and induction of clinical tolerance.

    BACKGROUND: Desensitization with drugs may be indicated in some clinical situations. Apart from large experiences with beta-lactam antibiotics and cotrimoxazole in hiv infection, experience with other drugs is limited. Rifampicin may elicit exanthema and urticaria, and their pathomechanisms are not known in detail. Since therapy with rifampicin may be indispensable in mycobacterial infections or against multiresistant staphylococcus aureus, desensitization may be indicated in some patients. OBJECTIVE: Report of immediate hypersensitivity to rifampicin and description of diagnostic and desensitization procedures. methods: We report 3 patients with immediate urticarial reactions to rifampicin. Diagnostic procedures included skin and in vitro tests (specific IgE, lymphocyte transformation test, LTT, and CAST). The non-irritant cutoff concentration was evaluated in 24 volunteers. A 7-day desensitization procedure was used. RESULTS: Only intradermal tests at a dilution of at least 1:10,000 (concentration of rifampicin approximately 0.006 mg/ml) were true positive, whereas in vitro tests (IgE, LTT and CAST) did not correctly identify hypersensitive patients. Two patients had positive accidental reexposure. All patients were successfully desensitized with rifampicin according to a slow 7-day protocol. CONCLUSIONS: Rifampicin rarely elicits immediate hypersensitivity symptoms which may be diagnosed by intradermal skin tests. in vitro tests did not contribute to the diagnosis. Therefore, an IgE-mediated mechanism remains to be proven. Desensitization with rifampicin using different protocols has been reported. In our 3 cases, clinical tolerance to rifampicin was achieved using a 7-day protocol.
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15/48. Immediate hypersensitivity type of occupational laryngitis in a welder exposed to welding fumes of stainless steel.

    BACKGROUND: Although upper respiratory symptoms have been reported to occur in welders, occupational laryngitis of immediate hypersensitivity type due to welding fumes of stainless steel has not been previously reported. methods: Occupational laryngitis was diagnosed based on the specific challenge test combined with the patient's history of occupational exposure and laryngeal symptoms. RESULTS: During the past few years, a 50-year-old man had started to experience laryngeal symptoms while welding stainless steel. The welding challenge test with stainless steel caused significant changes in the laryngeal status 30 min after challenge: increased erythema, edema, and hoarseness of the voice. The referent inhalation challenge test by welding mild steel was negative. CONCLUSION: The welding of stainless steel should be included in the etiological factors of occupational laryngitis of immediate hypersensitivity type.
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ranking = 29.299576280875
keywords = occupational exposure, exposure
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16/48. 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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17/48. Atopic allergy to chloramine-T and the demonstration of specific IgE antibodies by the radioallergosorbent test.

    Chloramine-T is a small molecular oxidizing agent that has been widely used as a disinfectant since the beginning of this century. It is generally used in a 5% solution but it is also supplied in powder form. Sporadic case reports of immediate-type sensitization to this agent associated with symptoms of asthma, rhinitis and urticaria have appeared during recent decades. In one of the reports, specific IgE antibodies in sera of four patients who developed asthmatic symptoms after exposure to chloramine-T were demonstrated using a radioimmuno-assay. Three cases of bronchial asthma in workers who had handled chloramine-T powder are described in the present report. Positive skin-prick test reactions to chloramine-T were observed and specific IgE antibodies to human serum albumin treated with chloramine-T were detected using the classic radioallergosorbent (RAST) technique in all three patients.
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18/48. Occupational asthma in bakeries caused by sensitivity to alpha-amylase.

    We report on a patient with asthma induced by occupational exposure to alpha-amylase derived from aspergillus oryzae, which is a component of bread additives. A type I hypersensitivity to this enzyme was demonstrated by means of skin test, immunoassay for specific IgE, and immediate bronchial provocation test response to an alpha-amylase extract.
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ranking = 29.299576280875
keywords = occupational exposure, exposure
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19/48. 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.
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20/48. Immediate contact hypersensitivity to acrylic acid.

    A chemical worker developed acute generalized urticaria after working with acrylate compounds in a laboratory. Immediate-hypersensitivity testing to acrylic acid yielded a severe local reaction. Testing with other acrylate compounds was negative. Re-exposure in the work-place to vapors of acrylic acid resulted in generalized urticaria. With the cooperation of the employer, the patient moved to a marketing job with no contact with acrylic acid and has remained free of urticaria since.
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