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Abstract

Allergologie select, Vol. 4/2020 (124-128)

Occupational diisocyanate asthma of a female professional driver – the importance of allergological diagnostics

Christian Eisenhawer, Monika Raulf, and Rolf Merget

Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University Bochum, Bochum, Germany
Diisocyanates continue to be one of the most frequent causes of occupational asthma worldwide. They are still indispensable in industrial use as components of coatings, glues, and polyurethane foams. In Germany, respiratory diseases due to diisocyanates can be compensated by the statutory accident insurance (according to BK-Nr. 1315). The present case report shows a rare case of sensitization against diisocyanates verified by skin prick test and serological testing. Due to these findings, a modified inhalation test with an extremely low initial diisocyanate concentration in the laboratory was performed, and a positive reaction could be detected already after an extremely low diisocyanate concentration. In addition, increases of fractional exhaled nitric oxide (FeNO) and eosinophils in induced sputum after inhalation testing were seen. The present case constellation underlines the particular importance of allergological tests for diagnostic clarification of the diagnosis of diisocyanate asthma.Correspondence to:
Dr. med. Christian Eisenhawer, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University Bochum, Competence Center Medicine, Bürkle-de-la Camp-Platz 1, 44789 Bochum, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (283-292)

Hypersensitivity pneumonitis to phthalic anhydride: Case description and review of the literature

Vera van Kampen¹, Anja Theile², Andrea Tannapfel², Christian Eisenhawer¹, Thomas Brüning¹, and Rolf Merget¹

¹Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), and ²Institute of Pathology, Ruhr University Bochum, Bochum, Germany
Hypersensitivity pneumonitis (HP) is a rare, mostly occupational allergic disease of the lungs. There are many inhalable antigens that can cause HP. Most are organic dusts, rarely chemicals. A clinical case of HP is presented in a cable production worker with exposure to plasticizers who was initially diagnosed with idiopathic pulmonary fibrosis. The presence of specific IgG antibodies (sIgG) to phthalic anhydride in the patient’s serum, together with reduced carbon monoxide diffusion capacity, hypoxemia at rest and on exertion, and the findings on computed tomography and histology, seemed to confirm the diagnosis of chronic HP due to phthalates, particularly as exposure to phthalate compounds at work was reported by the Technical Inspection Service. A review of the literature revealed that there is evidence of plasticizer alveolitis. While in four previous case reports phthalic anhydride was suspected as the cause of occupational HP because of workrelated symptoms, we were able to detect sIgG to phthalic anhydride for the first time. This case illustrates that phthalates, which have rarely been described as triggers of HP, should be considered in cases of suspected occupational HP.Correspondence to:
Dr. Vera van Kampen, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 9/2025 (58-65)

Legumes in bread baking: A hidden risk for an IgE-mediated inhalant allergy

Sabine Kespohl¹, Christian Eisenhawer¹, Silke Maryska¹, Ingrid Sander¹, Irene Mittermann², Martina Aumayr², and Monika Raulf¹

¹Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany, and ²MacroAssay Diagnostics, Vienna, Austria
New protein-rich flour blends from legumes are increasingly being processed for gluten-free bakery products, which may increase the risk of IgE-mediated sensitization through inhalation exposure. In the described case of a 29-year-old baker, work incapacity occurred due to respiratory complaints following exposure to various gluten-free baking ingredients. Occupationrelated sensitization to “chestnut pea flour” (flour from lightly roasted and ground yellow peas) was identified, while the patient showed no IgE sensitization to five other ingredients. Significant allergic respiratory reactions occurred during bronchial challenge test with “chestnut pea” extract. Based on the test results and typical workplace-related symptoms, recognition of occupational disease was recommended. Further identification of potential causal allergens using IgE blot and allergen component-resolved diagnostics revealed IgE bindings to typical storage proteins, 2S albumin and vicilin, as well as to Bet v 1 homologous of “chestnut pea” and non-specific lipid transfer proteins. This case illustrates that the processing of protein-rich legume flours can pose new sensitization risks for workers, which should be considered in the future.Correspondence to:
Dr. Sabine Kespohl, Department Competence Centre for Allergology/Immunology, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
Email: [email protected]

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