Occupational asthma due to deer dander

Past, present, and future of allergy in Korea

Korean allergology has made great progress in keeping pace with global scientific advances in spite of a short history. Outstanding academic and scientific researches have been performed in a variety of allergy fields in Korea. Epidemiologic studies revealed increasing prevalence of asthma and allergic diseases and considerable morbidity and mortality in Korea. Novel inhalant allergens such as citrus red mite and two-spotted spider mite as causes of asthma and allergic rhinitis have been discovered and reported in Korea. Bidirectional translational researches have been performed and are underway to elucidate the pathogenesis of asthma and allergy, mechanisms of airway inflammation and remodeling, and new therapeutic modalities for asthma and allergic diseases. Experimental asthma models of different phenotypes according to exposed levels of lipopolysaccharide or double-stranded RNA suggested the crucial role of the innate immunity in the development of allergic airway inflammation and a new insight for asthma pathogenesis, in which both Th1 and Th2 inflammation are involved. In the field of genetic researches, numerous genetic associations with asthma and asthma-related phenotypes, such as atopy, IgE production, and airway hyperresponsiveness, have been demonstrated in Korean population. The Easy Asthma Management (EAM) program, a computer-assisted asthma management program, is anticipated to facilitate the achievement of more successful clinical outcomes by filling the gaps between guidelines and actual practices. The Integration of these multi-disciplinary allergy research resources and translation of scientific achievements to the bedside and society will lead to better allergy and asthma control in Korea.

Occupational respiratory allergy to roe deer

BACKGROUND

Although scattered reports have been published on roe deer allergenicity, no systematic studies of allergenicity or possible cross-reactions have appeared.

OBJECTIVES

To describe 2 patients with occupational roe deer allergy, demonstrated by positive skin and conjunctival provocation test results, and to note cross-reactions to other animal (mainly cow) allergens.

METHODS

Two workers at animal rehabilitation centers were sensitized to roe deer. One patient had a history of rhinoconjunctivitis and the other a history of rhinoconjunctivitis and probable asthma. Both patients underwent skin testing with a standard battery of inhaled and epithelial allergens and with roe deer hair and dander extract and conjunctival provocation tests with roe deer hair extract. Immunodetection for IgE (both patients) and IgE immunoblot inhibition tests to determine inhibitory effect (1 patient) were also performed.

RESULTS

The results of skin tests and conjunctival provocation tests showed that both patients were sensitized to roe deer allergens. In one patient specific IgE to roe deer extract was detected, and this extract completely inhibited IgE binding to cow hair and dander extract in immunoblotting tests. Specific IgE to roe deer proteins could not be demonstrated in the other patient.

CONCLUSIONS

Our results suggest that roe deer epidermal derivatives can cause occupational respiratory disease in exposed workers and that allergy to this species should be considered in individuals who present with similar symptoms and exposure histories. Immunoblot inhibition studies suggested the possibility of cross-reaction between roe deer proteins and cow proteins.

Contact Urticaria to Giraffe Hair

BACKGROUND

Immediate-type hypersensitivity to animal proteins is a common problem in people occupationally exposed to animals.

METHODS

A 19-year-old female working as a voluntary zookeeper in her off-time suffered from hives on her forearms following contact to the fur of a giraffe. For diagnostic evaluation, skin prick tests, assessment of specific serum IgE antibodies, and basophil activation tests were performed.

RESULTS

Skin prick tests with a standard series of common aeroallergens were positive for various pollens. Prick testing with native materials was positive for extracts of hair from two different giraffe subspecies in the patient, but not in control subjects. By CAP-FEIA, no specific serum IgE antibodies to dander of a large variety of animals were found in the patient. In the basophil activation test, expression of the activation marker CD63 was induced by extract of giraffe hair on the cells from the patient, but not on those from unaffected controls.

CONCLUSIONS

This patient suffers from an 'exotic' immediate-type contact allergy to giraffe hair.

[Dermatologic occupationally relevant type I allergies]

In Germany the most frequent initial report of occupational disease is due to occupational skin diseases ("Berufskrankheitenanzeige nach Nr. 5101 der Berufskrankheitenverordnung") defined as "severe or recurrent skin diseases that force the discontinuation of any activity that causes or that could be causing the development, the worsening, or the recurrence of the skin disease". The majority of these occupational skin diseases consists of irritant and allergic contact dermatitis. In contrast, work place- related Type I allergy (contact urticaria syndrome) is less frequent, but carries the risk of systemic reactions. The clinical manifestations and pattern of exposure to Type I allergens in the work place are described.

Anaphylaxis to deer dander in a child: a case report

BACKGROUND

Hypersensitivity to deer dander is rarely reported, with only 26 cases in the literature. Ours is the youngest reported case and the first reported case of anaphylaxis on exposure to a live deer.

OBJECTIVE

Evaluation of a case of anaphylaxis in a young boy upon exposure to a deer.

METHODS AND RESULTS

A 4-year-old boy experienced hives, swelling, and shortness of breath requiring epinephrine following a deer exposure. He had one mild reaction 5 days prior to his anaphylaxis with an indirect exposure. A deer dander extract was made from fur supplied by the patient's mother. IgE-mediated reactivity was positive for deer and cattle by both selective skin prick method and RAST results.

CONCLUSION

Hypersensitivity to wild animals can lead to life threatening anaphylaxis, even in children. Passive transfer of antigen may occur, but needs further investigation.

Occupational airway sensitizers: an overview on the respective literature

BACKGROUND

Worldwide, there is rigorous scientific activity concerning the further development of work safety regulations involving airway-sensitizing substances. Technical directives on hazardous substances are enforced in several countries and are being continuously updated. The European Union has established a code for several occupational substances, now labeled R 42 ("may cause sensitization by inhalation").

METHODS

We present an overview of the literature dealing with allergic occupational asthma. The literature was selected according to criteria of study design and diagnostic test methods. Approximately 300 publications were reviewed including both epidemiological studies and individual case reports.

RESULTS

Airway sensitizers are systematically arranged and separately listed according to chemicals and their origin from animals, plants, and microorganisms. The clinical data as well as threshold limit values (TLV) and R 42 labeling of 250 airway-sensitizing substances are presented.

CONCLUSIONS

The most common sensitizing substances causing occupational asthma were dust of cereal flours, enzymes, natural rubber latex, laboratory animals as well as low molecular substances such as isocyanates and acid anhydrides.