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21/48. Longitudinal study of tolyl-reactive IgE antibodies in workers hypersensitive to TDI.

    Three workers with TDI hypersensitivity were evaluated for IgE antibodies to TDI over a period of 13 months. A radioallergosorbent test (RAST) system was employed using p-toly(mono)isocyanate-human serum albumin antigen covalently bound to cyanogen bromide-activated paper discs. IgE antibody titers were consistently elevated in two individuals who experienced several bronchial hypersensitivity responses to TDI during the study period. The responses were either solely asthmatic or asthmatic accompanied by cutaneous hypersensitivity reactions. By contrast, antibody titers in a third subject who had not experienced any hyersensitivity reactions during the study period continually decreased, falling to insignificant levels after 12 months. In the absence of renewed TDI exposure, sensitive workers may have titers indistinguishable from those of workers exposed to TDI but without sensitivity to the chemical.
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22/48. Occupational asthma caused by guar gum.

    Some vegetable gums have been reported to cause asthma. We describe three subjects who were exposed at work to guar gum, which is derived from the outer part of Cyanopsis tetragonolobus, a vegetable that grows in india. The first subject worked for a pharmaceutical company; the second and third subjects worked at a carpet-manufacturing plant. All three subjects developed symptoms of rhinitis and asthma after the onset of exposure to guar gum. All subjects were atopic and demonstrated mild bronchial hyperresponsiveness to inhaled histamine at the time they were observed. Skin prick tests demonstrated an immediate skin reaction to guar gum. All three subjects had high levels of serum IgE antibodies to guar gum. Specific inhalation challenges in which the three subjects were exposed for short intervals (less than or equal to 4 minutes) to powder of guar gum elicited isolated immediate bronchospastic reactions in two subjects and a dual reaction in the other subject.
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23/48. Basophil histamine release. A study in allergy to suxamethonium.

    A patient who suffered a severe hypotensive episode after induction of anaesthesia, was subsequently found to show positive skin-test responses to suxamethonium. Investigation revealed that suxamethonium induced basophils from the patient to release histamine to an extent comparable to that found after exposure to anit-IgE. basophils from control subjects showed no such response. Basophil histamine release may offer a useful approach to the investigation of adverse drug reactions.
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24/48. Occupational sensitivity to Alphitobius diaperinus (Panzer) (lesser mealworm).

    Alphitobius diaperinus is an important beetle in the grain and poultry industries. We evaluated three individuals with work-related symptoms of asthma, rhinitis, conjunctivitis, urticaria, and angioedema on exposure to the insect. Prick skin tests with extracts prepared from the larval, pupal, and adult life stages were positive in all three patients. Specific IgE antibodies to these extracts were demonstrated by RAST or radioimmunoassay. RAST and radioimmunoassay inhibition confirmed the specificity of IgE binding and further demonstrated immunologic cross-reactivity between the three life stages. Peripheral blood leukocytes from two of the individuals demonstrated significant histamine release when they were compared with cells from nonexposed atopic and normal control subjects. The proteins in the extracts of each life stage were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. More than 30 protein bands were detected in each of the extracts; however, the patterns of separation were different for each life stage. After immunoblotting and autoradiography, IgE-binding proteins were recognized by sera from all three individuals in the larval extract at 90 kilodaltons (kd), in the pupal extract at 90, 64, and 38 kd, and in the adult extract at 84 kd. Additionally, several other proteins were identified as being allergenic in some of the patients. We conclude that these three patients developed IgE-mediated sensitivity to A. diaperinus antigens as the result of occupational exposure. To our knowledge, this is the first description of sensitivity to this grain beetle.
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keywords = occupational exposure, exposure
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25/48. hypersensitivity to natural latex.

    rubber hypersensitivity is well described but usually as a contact dermatitis caused by chemicals added during the process of making natural latex or synthetic rubber. IgE-mediated reactions, mainly contact urticaria, have rarely been reported in europe. We report a case of immediate hypersensitivity to latex. A 34-year-old female operating room nurse developed hand eczema to natural latex. On two occasions, while she was gloving for surgery, she had the following reactions: flushing, tachycardia, urticaria, angioedema, wheezing, and light-headedness. Prick and patch testing to thiuram mix, mercaptobenzothiazole, phenylenediamine mix, and carbamate mix (common rubber additives) were negative. Prick tests to natural latex elicited a 4 reaction associated with immediate flushing, tachycardia, urticaria, and light-headedness. Five control subjects did not react. IgE antibodies to latex by RAST demonstrated 17.7% binding (control, 4%). This case demonstrates that natural latex can cause IgE-mediated symptoms. The route of exposure was cutaneous absorption of relevant latex allergens. As the use of latex rubber products continues to escalate, more cases are likely to occur.
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26/48. Hypochlorite sensitivity in man.

    observation of an individual with immediate-type reaction following exaggerated dermal exposure to hypochlorite-containing cleaning products prompted review of similar hypersensitivity reactions attributed to hypochlorite or other highly reactive chemicals. This review confirms isolated incidences of hypochlorite sensitivity of the delayed type (allergic contact dermatitis), as well as immediate-type reactions from inhalation or topical challenge of sensitized individuals. We conclude that it is possible that excessive and prolonged exposure to hypochlorite may in some cases result in irritation and damage to the skin. This potentially gives rise to altered proteins which in rare cases may cause hypersensitivity. This reaction is common to other reactive small molecules with a strong irritant action.
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27/48. Contact urticaria and anaphylaxis to latex.

    Contact urticaria and anaphylaxis to latex is reported in two patients. One case was associated with oral and vaginal exposure to a condom and the other with rectal exposure to a latex glove. Both patients had positive reactions to scratch or prick tests to pieces of latex, as well as latex radioallergosorbent test (RAST). The diagnosis of contact urticaria to latex is difficult to make on the basis of history alone.
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28/48. Significant changes in nonspecific bronchial responsiveness after isolated immediate bronchospecific reactions caused by isocyanates but not after a late reaction caused by plicatic acid.

    Although late bronchospastic reactions after exposure to antigenic and sensitizing agents usually significantly alter bronchial responsiveness to histamine or methacholine, presumably by causing bronchial inflammation, isolated immediate bronchospastic reactions do not induce such changes. We studied three subjects who demonstrated different patterns of reaction. The first individual was diagnosed as having occupational asthma to red cedar. This was confirmed by specific inhalation challenges that resulted in late bronchospastic reaction. No significant changes in the provocative concentration of histamine causing a 20% fall in FEV1 (PC20) were found 1 day after this reaction. Two weeks later, serial assessments (five and six, respectively) of PC20 histamine were recorded on control days and up to 48 hours after exposure to plicatic acid, which caused a late bronchospastic reaction with a maximum fall of 37% in FEV1. No significant changes in PC20 were found; the maximum variations on control days were 0.36 to 0.74 mg/ml, and on active days, from 0.37 to 0.59 mg/ml. By contrast, two other subjects, who demonstrated isolated immediate reactions after exposure to diphenylmethane diisocyanate, had significant changes in PC20 histamine and methacholine, in one subject from 3.1 mg/ml to 0.6 mg/ml 8 hours after exposure, and in the other subject, from 61.0 to 7.4 mg/ml 7 hours after exposure, with recovery during the next few days. These examples demonstrate that the pattern of nonspecific bronchial responsiveness after immediate and late bronchospastic reactions can be different from what has previously been described. Immediate bronchospastic reactions may lead to bronchial hyperresponsiveness, whereas late asthmatic reactions do not always induce changes in bronchial responsiveness.(ABSTRACT TRUNCATED AT 250 WORDS)
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29/48. Oro-facial granulomatosis. Response to elemental diet and provocation by food additives.

    We report the case of an 8.5-year-old girl with oro-facial granulomatosis associated with clinical atopy, in whom relapse of her granulomatous disorder was shown to be related to exposure to specific food additives, viz. carmoisine, sunset yellow and monosodium glutamate. Treatment with a restricted diet resulted in considerable regression in the facial swelling which has been maintained for 6 months. A brief account of the histological features, both under light and electron microscopy, is given, together with a description of the use of nuclear magnetic resonance scanning in the assessment of this disease. The patient had no evidence to support a diagnosis of sarcoidosis or Crohn's disease.
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30/48. The late asthmatic response.

    Since LARs are associated with increases in airways reactivity, their significance may go well beyond the increase in symptoms due just to the allergen exposure. This is especially true since the increase in non-specific airways reactivity can last for weeks after a single exposure to allergen. Every effort should be made to search for possible allergic triggers in patients suspected to have LARs. Careful attention to historical information and skin test reactivity are critical in this evaluation. In situations where this approach is not revealing and where serious concerns remain about potential environmental triggers, a bronchial challenge to the suspected antigen can be considered. Since the nonspecific airways reactivity in patients with LAR may possibly be due to inflammation in the airways, the potential risk of transient induction of airways inflammation must be carefully weighed against the value of information that can be obtained from this procedure. Bronchial challenge should be performed only in an inpatient setting by experienced personnel under the supervision of a physician. A full explanation of the potential risks and benefits of this type of evaluation must be given to the patient and family. Treatment is primarily directed at allergen avoidance with use of a prophylactic drug, such as cromolyn sodium, when allergen avoidance is not possible.
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