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1/11. tobacco allergy: demonstration of cross-reactivity with other members of solanaceae family and mugwort pollen.

    BACKGROUND: tobacco is a plant belonging to the solanaceae family. This plant is usually used as a contact insecticide for several infestations in some areas, such as the Canary islands. Allergy induced by inhalation of this plant is unusual. Identification of the potential allergen in growing areas is essential. OBJECTIVE: We report a patient with occupational sensitivity to an aqueous solution of cut tobacco whose clinical manifestations were rhinoconjunctivitis and urticaria. Past medical history was significant for seasonal allergic rhinoconjunctivitis to mugwort pollen and oral allergy syndrome with avocado. methods: Green tobacco and cured tobacco leaf extracts were prepared, skin prick tests were performed with green tobacco, cured tobacco leaf extracts, and certain aeroallergens. Conjunctival challenge test was carried out with green tobacco and cured tobacco leaf extract. serum-specific IgE against tobacco leaf was performed by commercial CAP. CAP inhibition experiments were carried out with tobacco and artemisia vulgaris. RESULTS: Skin prick tests and conjunctival challenge tests with green tobacco and cured tobacco leaf extracts were positive, as well as serum-specific IgE by CAP, indicating an IgE-mediated sensitization. CAP inhibition experiments were carried out and it was found that tobacco, mugwort pollen, and tomato extracts inhibited the binding of the patient's serum to solid-phase tobacco leaf. No inhibition was observed when alternaria, D. pteronyssinus, and potato were used as control inhibitors. Inhibition of immunoCAP to mugwort was obtained with mugwort and tobacco extracts and no cross-reactivity to D. pteronyssinus was shown. CONCLUSION: The results suggest that tobacco can induce IgE-mediated reactions that are mediated by the existence of common antigenic epitopes between tobacco and mugwort pollen. This allergy can be a hazard of employment in the agricultural areas.
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2/11. New occupational allergen in citrus farmers: citrus red mite (Panonychus citri).

    BACKGROUND: There have been several reports of occupational allergy to spider mites (tetranychidae), but no published report has described citrus red mite (CRM, Panonychus citri)-induced occupational asthma confirmed by specific bronchial challenge. OBJECTIVE: The purpose of this study was to evaluate clinical and immunologic characteristics of CRM-induced occupational asthma. methods AND RESULTS: We encountered 16 cases of CRM-induced occupational asthma among farmers cultivating citrus fruits. Asthmatic attacks corresponded closely with their work on citrus farms. The mean duration of the latent period was 12.9 (range 7 to 20) years. During their first visit to our clinic, nine patients with FEV1 lower than 70% of predictive value showed reversible airway obstruction after inhalation of bronchodilator, and seven with FEV1 greater than 70% of predictive value showed airway hyperresponsiveness to methacholine. Fifteen of the 16 also complained of recurrent nasal symptoms, which had developed at an earlier time than the asthmatic symptoms. They showed strong positive reactions to CRM extract on skin prick test (A/H ratio > or = 1.0) and had high serum specific IgE antibody against CRM which was detected by ELISA. Skin prick test with common inhalant allergens revealed that 10 had an isolated positive response to CRM with negative results to common inhalant allergens in their environment. The ELISA inhibition tests with CRM demonstrated significant inhibitions by CRM in a dose-dependent manner, while minimal inhibitions were noted by D. pteronyssinus and mugwort allergens. CONCLUSION: These findings suggest that CRM could induce IgE-mediated bronchoconstriction in exposed workers on citrus farm.
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3/11. Occupational contact dermatitis to hydrangea.

    Two female commercial hydrangea growers, from separate nurseries, presented with similar hand and facial dermatitis. Both had a hand dermatitis affecting particularly the first three fingers and backs of both hands and complained of a recurrent facial dermatitis affecting the forehead, around both the eyes and bridge of nose. They related their dermatitis to their work. patch tests confirmed allergy to all components of hydrangeas including petal, leaf and stem. Avoidance resulted in resolution of their dermatoses. Allergy to hydrangeas has been reported previously although infrequently.
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4/11. Immediate type of allergy in statis growers.

    Three statis growers complaining of immediate allergic symptoms induced by harvesting statis in a plastic greenhouse were examined to clarify their allergic conditions. Distinct positive reactions in the intradermal test and nasal and eye provocation test to the statis extracts were shown in all three cases. High score of radioallergosorbent test (RAST) IgE and remarkable RAST inhibitory effects to the statis extracts were seen in these cases. The immunologic cross-reactivity between statis and chrysanthemum was absent in the RAST inhibition in the patient labeled case C who had complained of the same allergic symptoms when handling chrysanthemums in the off-season for harvesting statis. Those results indicated that the allergic conditions of the present cases were from an immediate type of allergy mediated by a specific IgE antibody to the statis extract.
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5/11. Respiratory allergy to peach leaves and lipid-transfer proteins.

    BACKGROUND: Several lipid-transfer proteins (LTPs) have been identified as important food allergens, especially in fruits of the rosaceae family. The major peach (prunus persica) allergen has been identified, sequenced and designated Pru p 3. OBJECTIVE: To present Pru p 3 as an aeroallergen able to induce occupational asthma. methods: A thorough investigation was performed in a fruit grower with occupational asthma. Skin prick-prick tests with peach leaves and prick tests with perennial respiratory allergens and pollens, fruits and peach leaf extracts were done. serum-specific IgE was tested for peach leaf, peach fruit, peach skin and respiratory allergens that were positive in skin prick tests. Specific bronchial provocation tests (BPTs) with extracts of peach leaf were also done. Before and 24 h after the BPT, BPTs with methacholine and sputum induction were done. The IgE reactivity pattern to peach leaf and fruit extracts and to Pru p 3 was identified by using SDS-PAGE and immunoblotting. Blotting inhibition of peach leaf extract by Pru p 3 was also performed. The putative allergen was quantified in leaf and fruit skin extracts with ELISA based on an anti-Pru p 3 antibody. RESULTS: skin tests were positive for peach leaf and fruit. The BPT was positive, with immediate and delayed response. This test induced a decrease in PD20 (dose of agonist that induces a 20% fall in FEV1) methacholine and an increase in eosinophils and eosinophil cationic protein in sputum. Peach leaf extract contained concentrations of Pru p 3 similar to those found in peach skin. Specific IgE immunodetection showed that patient's sera reacted with Pru p 3, and with a single major band from the peach leaf extract fully inhibited by Pru p 3. CONCLUSION: Pru p 3 from peach leaves can act as a respiratory allergen and cause occupational rhinoconjunctivitis and asthma.
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6/11. Occupational allergic contact dermatitis from lichens in present-day finland.

    lichens are abundant in forests, living on trees, soil, stones and rocks. They contain usnic acid and other lichen acids that are contact allergens. lichens and liverworts cause woodcutter's dermatitis, eczema that appears in the forest on the bare skin areas, especially in cold and wet weather. Occupational allergic contact dermatitis from lichens occurs in forestry and horticultural workers and in lichen pickers. lichens can cause immediate allergy, contact urticaria, rhinitis and asthma and probably also photoallergic contact dermatitis. lichens are used for the manufacture of oak moss absolute, a fragrance constituent. Oak moss absolute contains lichen acids and is one of the commonest contact allergens. Lichen acid allergy develops either from contact with lichens or from fragrances. We describe 4 cases of occupational allergic contact dermatitis from lichens during the past decade: 2 were farmers and 2 gardeners. 3 of them had allergic reactions to fragrance mix and oak moss absolute. Lichen contact allergy is an old, partly forgotten, syndrome that should be remembered for symptoms in contact with barked wood or wood dust.
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7/11. Occupational respiratory allergy to cyclamen pollen: a case report.

    A case of cyclamen (cyclamen persicum) pollen allergy is described on a flower cultivator. The diagnosis was assessed by skin test, methacoline test, nasal provocation test and RAST. SDS-PAGE and immunoblotting have shown an intense response against a 18 kDa component and a weaker one at 100 Kda. A RAST inhibition against cupressus sempervirens and acacia floribundia showed no identity with cyclamen. This case confirm the cyclamen allergenity, in professional exposure. The nasal challenge prove to be very useful to confirm allergic sensitizations an we emphasize the necessity of preventive measures of protection for those florists who cultivate cyclamen plants.
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8/11. Immediate-type allergy related to okra (hibiscus esculentus Linn) picking and packing.

    Two workers (cases A and B) engaged in picking and packing okra who had complaints of work-related allergic symptoms showed distinct positive intradermal reactions to two brands of okra extracts only with thresholds of 1 x 10(-8) w/v for Case A and 1 x 10(-6) w/v for Case B. Both also showed positive reactions to okra extracts in the Prausnitz-Kustner test and in the provocative nasal test. The radioallergosorbent test scores to the okra extract were determined to be 2 (defined as clear positive) for Case A and 1 (border line) for Case B. These findings indicated that the allergic conditions of these cases were from an IgE-mediated immediate-type allergy induced by handling okra. To confirm the etiology of the two cases 14 farmers engaged in picking and packing okra were examined. Among them, 8 subjects (57%) showed positive intradermal reactions to okra extracts. A close association between intradermal reactions to okra extracts and complaints of work-related allergic symptoms was seen in these subjects. These results confirm that the okra may be capable of inducing IgE-mediated immediate-type allergy to workers handling okra.
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9/11. Occupational asthma in greenhouse tomato growing.

    An employee working in a commercial tomato growing greenhouse developed asthma of increasing severity over a period of 8 years. She was diagnosed as having occupational asthma by a chest physician. The cause was obscure and initial allergy testing was negative. Further investigation of the workplace gave rise to suspicion of allergy to insects. Immunological testing confirmed sensitization to Red Spider Mite.
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10/11. Occupational type I allergy to Christmas cactus (Schlumbergera).

    The study aimed to determine whether occupational contact urticaria and symptoms of mucous membranes, reported by five workers in a cactus nursery, were due to IgE-mediated allergy to Schlumbergera cacti. The five persons had positive skin prick tests to the plants as is and positive histamine-release tests, and in three of them specific IgE to the cacti could be demonstrated by Maxisorp RAST and immunoblotting. Four of the patients were atopic, and the fifth had a positive skin prick test to cat dander, indicating latent atopy. Skin prick tests with cacti were negative in most atopic volunteers, and all had negative histamine-release tests. The results suggest a true IgE-mediated allergy to the cacti, and both genetic predisposition and close contact with the plants at work seem to be important factors in the emergence of this new occupational allergy.
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