Case Report
Unusual allergen in a butcher with respiratory symptoms
Ingrid Sander, Claus Keller, Christina Czibor, Ursula Meurer, Rolf Merget and Monika Raulf
Volume 4 (2020) p. 105 - 109
Abstract
Allergologie select, Volume 4/2020 (105-109) ©2020 Dustri-Verlag Dr. K. Feistle ISSN 2512-8957 DOI 10.5414/ALX02126E e-pub: December 2, 2020 Received August
Unusual allergen in a butcher with respiratory symptoms
Ingrid Sander1, Claus Keller2, Christina Czibor1, Ursula Meurer1, Rolf Merget1 and Monika Raulf1
1Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, and 2Medical Practice for Pulmonary and Bronchial Medicine, Allergology and Environmental Medicine, Frankfurt am Main, Germany
A 37-year-old butcher developed respiratory symptoms during sausage and chicken production in a large company. In addition to various spices, the enzyme transglutaminase was a possible cause. The lung function test showed mild partial reversible airway obstruction and severe bronchial hyperresponsiveness. The IgE test showed sensitizations to various spice mixtures, coriander (0.74 kU/L), and to the ImmunoCAPbound transglutaminase preparation from the workplace (7.12 kU/L). The skin prick tests with this transglutaminase were also positive. In the immunoblot of this preparation, a 40-kD protein reacted with the patient’s IgE and was identified as transglutaminase from Streptomyces mobaraensis by inhibition experiments. This is the first case of a butcher with an allergy to transglutaminase. After moving to a small enterprise without enzyme use, his symptoms improved. Sensitization and the course of the symptoms indicate a dominant role of transglutaminase in the patient’s allergic asthma.Correspondence to:
Dr. Ingrid Sander, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum, Center of Allergology/Immunology, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Email: [email protected]
Case Report
Occupational diisocyanate asthma of a female professional driver – the importance of allergological diagnostics
Christian Eisenhawer, Monika Raulf, and Rolf Merget
Volume 4 (2020) p. 124 - 128
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]
Case Report
Occupational immediate type allergy to soapnut and quillaja bark
Rolf Merget, Monika Raulf, and Ingrid Sander
Volume 5 (2021) p. 77 - 81
Abstract
Allergologie select, Vol. 5/2021 (77-81)
Occupational immediate type allergy to soapnut and quillaja bark
Rolf Merget, Monika Raulf, and Ingrid Sander
Institute for Prevention und Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Germany
A 58-year-old non-atopic chemical worker complained about work-related asthma and rhinoconjunctivitis about 4 years after exposure to quillaja bark and soapnut. Bronchial hyperresponsiveness was demonstrated after withdrawal of medication for 12 hours. Skin prick tests with extracts from quillaja bark and soapnut from the workplace were positive, but ImmunoCAP was positive only with quillaja bark, probably due to the low protein content of the extract from soapnut. Sensitizations to quillaja bark and soapnut, but not to saponin were demonstrated by immunoblot. An inhalation test with a dosimeter was positive with the soapnut extract. A link between disease and exposure was documented by serial measurements of exhaled nitric oxide at and off work, despite preventive measures. A diagnosis of occupational allergy due to quillaja bark and soapnut was made. Further exposure reduction was recommended.Correspondence to:
Prof. Dr. med. Rolf Merget, Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung, Institut der Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Email: [email protected]
Guideline
Workplace-related inhalation test (AIT) – Specific inhalation challenge (SIC) – S2k Guideline of the German Society for Occupational and Environmental Medicine e.V. (DGAUM), the German Society for Pneumology and Respiratory Medicine e.V. (DGP)
Alexandra M. Preisser, Dirk Koschel, Rolf Merget, Dennis Nowak, Monika Raulf, and Jan Heidrich
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Volume 5 (2021) p. 315 - 334
Abstract
Allergologie select, Vol. 5/2021 (315-334)
Workplace-related inhalation test (AIT) – Specific inhalation challenge (SIC) – S2k Guideline of the German Society for Occupational and Environmental Medicine e.V. (DGAUM), the German Society for Pneumology and Respiratory Medicine e.V. (DGP)
Alexandra M. Preisser1, Dirk Koschel2, Rolf Merget3, Dennis Nowak4, Monika Raulf3, and Jan Heidrich1
1Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, 2Department of Internal Medicine and Pneumology, Fachkrankenhaus Coswig, Lung Center, Coswig, Division of Pneumology, Medical Department I, University Hospital Carl Gustav Carus, Dresden, 3Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, and 4Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, CPC Comprehensive Pneumology Center Munich, DZL, Deutsches Zentrum für Lungenforschung Munich, Germany
Correspondence to:
PD Dr. med. Alexandra M. Preisser, Arbeitsgruppe Klinische Arbeitsmedizin, Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf (UKE), Seewartenstraße 10, Haus 1, 20459 Hamburg, Germany
Email: [email protected]
Original
What should be tested in patients with suspected mold exposure? Usefulness of serological markers for the diagnosis
Sabine Kespohl, Verena Liebers, Silke Maryska, Ursula Meurer, Claudia Litzenberger, Rolf Merget, and Monika Raulf
Volume 6 (2022) p. 118 - 132
Abstract
Allergologie select, Vol. 6/2022 (118-132)
What should be tested in patients with suspected mold exposure? Usefulness of serological markers for the diagnosis
Sabine Kespohl, Verena Liebers, Silke Maryska, Ursula Meurer, Claudia Litzenberger, Rolf Merget, and Monika Raulf
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
The associations of mold exposure, IgE-mediated sensitization, inflammatory markers, and respiratory symptoms were analyzed in 46 exposed and 23 nonexposed individuals. Both exposure and clinical symptoms were assessed by questionnaire. Specific (s)IgE to mold mixture (mx1) was significantly higher and found more frequently in exposed (41%) than non-exposed individuals (17%), which was not observed for sIgG to mold mix (Gmx6). Notably, exposed asthmatics were more frequently sensitized to molds (55%) compared to exposed non-asthmatics (18%). In addition, the serum concentrations of club cell protein (CC16) were significantly lower in exposed subjects, especially in asthmatics. Positive associations were observed among mold sensitization, asthma, and mold exposure, but not in subjects with predominantly environmental sensitizations without mold sensitization. Thus, sIgE to mx1 but not sIgG to Gmx6 is a useful diagnostic marker to verify mold-associated respiratory symptoms.Correspondence to:
Dr. rer. nat. Sabine Kespohl, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Deutsche Gesetzliche Unfallversicherung e.V. (DGUV), Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Email: [email protected]
Case Report
Hypersensitivity pneumonitis to phthalic anhydride: Case description and review of the literature
Vera van Kampen, Anja Theile, Andrea Tannapfel, Christian Eisenhawer, Thomas Brüning, and Rolf Merget
Volume 8 (2024) p. 283 - 292
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]
