Occupational allergic rhinitis reaction to psyllium

Occupational rhinitis in the Slovak Republic--a long-term retrospective study

BACKGROUND

Allergic and non-allergic rhinitis ranks among the common occupational health problems. However, data on the incidence of occupational rhinitis are lacking, since comprehensive studies are rare.

METHODS

The study includes a group of patients in the Slovak Republic who were reported as having occupational rhinitis in the years 1990-2011. The following parameters were tracked in the investigated sample: age, gender, number of cases by individual years, occupations, causative factors and the length of exposure to the given agent. Possible progression of rhinitis to bronchial asthma was evaluated as well. The diagnostic algorithm was also analysed retrospectively, which included skin tests, the examination of specific IgE antibodies and nasal provocation tests.

RESULTS

A total of 70 cases of occupational rhinitis were reported. The disease most often occurred in food industry workers (50% of cases). The most common aetiological factor was flour. Among other relatively common allergens were synthetic textile, wool, cotton and different types of moulds. Significant agents were also different chemical factors causing allergic and irritant rhinitis. The average length of exposure was 14.8 years. Exposure was shorter in men than in women (11 years vs. 16 years) (p = 0.04). Bronchial asthma as a comorbidity was diagnosed in 13 patients (19.7%). The critical diagnostic method on the basis of which the causal association between rhinitis and work environments was confirmed in 59% of cases was skin test; confirmation of the occupational cause using nasal provocation test was less frequent (18%).

CONCLUSION

Food industry, textile industry and agriculture were the most risky occupational environments. Workers in these sectors require preventive intervention. In case of showing rhinitis symptoms it is necessary to confirm the occupational aetiology of the disease by the objective diagnostic methods. Since occupational rhinitis mostly precedes the occupational asthma, the elimination from the workplace is necessary.

Occupational rhinitis

Work-related rhinitis, which includes work-exacerbated rhinitis and occupational rhinoconjunctivitis (OR), is two to three times more common than occupational asthma. High molecular weight proteins and low molecular weight chemicals have been implicated as causes of OR. The diagnosis of work-related rhinitis is established based on occupational history and documentation of immunoglobulin E (IgE) mediated sensitization to the causative agent if possible. Management of work-related rhinitis is similar to that of other causes of rhinitis and includes elimination or reduction of exposure to causative agents combined with pharmacotherapy. If allergens are commercially available, allergen immunotherapy can be considered.

Occupational rhinitis

Work-related rhinitis, which includes work-exacerbated rhinitis and occupational rhinitis, may be two to three times more common than occupational asthma. Both high molecular weight proteins and low molecular weight chemicals have been implicated as causes of occupational rhinitis. A diagnosis is established based on occupational history and, if appropriate, documentation of IgE-mediated sensitization to the causative agent. Management of work-related rhinitis is similar to that of non-work-related rhinitis and includes elimination or reduction of exposure to offending agents combined with pharmacotherapy. If treatment allergens are commercially available, allergen immunotherapy may also be considered if appropriate.

Rhinitis in the geriatric population

The current geriatric population in the United States accounts for approximately 12% of the total population and is projected to reach nearly 20% (71.5 million people) by 20301. With this expansion of the number of older adults, physicians will face the common complaint of rhinitis with increasing frequency. Nasal symptoms pose a significant burden on the health of older people and require attention to improve quality of life. Several mechanisms likely underlie the pathogenesis of rhinitis in these patients, including inflammatory conditions and the influence of aging on nasal physiology, with the potential for interaction between the two. Various treatments have been proposed to manage this condition; however, more work is needed to enhance our understanding of the pathophysiology of the various forms of geriatric rhinitis and to develop more effective therapies for this important patient population.

Corneal toxicity from topical ocular and systemic medications

PURPOSE

To review what is known about the adverse effects on the cornea from various classes of medications. New data from previously unreported cases of drug-related corneal toxicity are included.

METHODS

Data are garnered from a Medline literature review and from case reports collected by the World Health Organization, the Food and Drug Administration, and the National Registry of Drug-Induced Ocular Side Effects.

RESULTS

Aminoglycosides, bisphosphonates, chemotherapeutic medications, cyclooxygenase-2 inhibitors, fluoroquinolones, glaucoma eye drops, topical iodine, nonsteroidal anti-inflammatory eye drops, preservatives in eye drops, retinoids, topical anesthetics, topical steroids, and some herbal medications can cause corneal toxicity in some patients.

CONCLUSION

Ophthalmologists need to be aware of potential corneal toxicities that can arise from commonly prescribed medications.

Psyllium-associated anaphylaxis and death: a case report and review of the literature

BACKGROUND

Psyllium use has increased significantly in the United States in part due to its lipid-lowering property. The increased prevalence of consumption has led to its recognition as an emerging food allergen.

OBJECTIVES

To report the case of a 42-year-old woman who experienced fatal anaphylaxis after ingesting a psyllium-based product and to review the literature.

METHODS

The MEDLINE database was searched for articles from 1966 to 2002 using the keywords psyllium or ispaghula and each of the following: allergy, hypersensitivity, anaphylaxis, and asthma. Both English and non-English articles were included.

RESULTS

Psyllium hypersensitivity has been well described in health care workers and pharmaceutical plant employees. Clinical manifestations of allergy range from upper respiratory tract symptoms on inhalation to anaphylaxis on ingestion. The prevalence of sensitization varies between these 2 groups. The allergenic epitope is not known.

CONCLUSIONS

We present a case of psyllium hypersensitivity that resulted in death. There is a clear association between atopy and psyllium allergy. The case underscores the fact that even nonprescription "natural" products can be harmful to people with allergies.

Occupational rhinitis

OBJECTIVE

To define occupational rhinitis, classify its various causes, review the steps in diagnosis, and describe the nonpharmacologic and pharmacologic management principles.

DATA SOURCES

A review of MEDLINE articles in English on occupation rhinitis for January 1, 1970, through December 31, 2001, was performed. In addition, references were identified from bibliographies of relevant articles and books.

STUDY SELECTION

The expert opinion of the author was used to select the relevant articles for the review.

RESULTS

Occupational rhinitis is the episodic, work-related occurrence of sneezing, nasal discharge, and nasal obstruction. It frequently coexists with asthma but may present alone. Occupational rhinitis can be caused by heightened olfactory awareness, nonspecific inflammation of the nose, exposure to a high concentration of irritating and soluble chemical gases, or IgE mechanisms. The history and physical examination are the most important components to the workup of the patient. A site visit to the specific work area may give helpful insights to the patients' exposure. In the case of IgE-mediated allergic occupational rhinitis, skin testing or serologic testing may be useful. Greater objectivity to the diagnosis can be obtained through nasal challenge and the rapidly developing technique of rhinomanometry. Nonpharmacologic management (environmental control) and pharmacotherapy, such as that used in allergic rhinitis, should both be instituted.

CONCLUSIONS

Although it does not have the same impact as occupational asthma, occupational rhinitis causes distress, discomfort, and work inefficiency. Attention to principles of management involving nonpharmacologic and pharmacologic measures will spare the patient the symptoms of occupational rhinitis.

Occupational rhinitis

This article aims to define occupational rhinitis, classify its various causes, review the steps in its diagnosis, and describe its nonpharmacologic and pharmacologic principles of management. Occupational rhinitis frequently coexists with asthma but also occurs alone. Although it does not have the same impact as occupational asthma, occupational rhinitis causes distress, discomfort, and work inefficiency. By concentrating on the patient's workplace, the clinician has an opportunity to practice preventive medicine: to recognize substances in the patient's micro- and macroenvironment that are causing the problems and then to intervene by altering the environment or removing the patient from the environment.

Mechanisms of wood smoke-induced increases in nasal airway resistance and reactivity in rats

We investigated the mechanisms of wood smoke-induced increases in nasal airway resistance (RNA) and airway reactivity in anesthetized rats. Delivery of wood smoke into a functionally isolated nasal airway produced an increase in RNA, which was attenuated by CP-96,345 [a tachykinin NK(1) receptor antagonist; (2S,3S)-cis-2-(diphenylmethyl)-N-((2-methoxyphenyl)-methyl)-1-azabicyclo(2.2.2.)-octan-3-amine] or atropine. Additionally, smoke pre-exposure animals displayed a greater amplitude and a longer duration of RNA responses to capsaicin or histamine provocation, as compared to air controls. This enhanced airway reactivity to capsaicin or histamine was largely alleviated by CP-96,345 or atropine. The nasal secretory responses to capsaicin or histamine in smoke pre-exposure animals were similar to those in air controls. We concluded that (1) reflex cholinergic and tachykininergic mechanisms play important roles in wood smoke-induced increases in nasal airway resistance and airway reactivity, and (2) this nasal airway hyperreactivity might not be due to an exaggerated secretory response, but is presumably due to augmented nasal swelling.

Occupational rhinitis

BACKGROUND

Occupational rhinitis is a common but generally unappreciated entity. It frequently exists with asthma but may present alone. While not as dramatic a presentation as bronchial asthma, it nevertheless results in significant discomfort and work inefficiency. The history and physical examination are the most important components to the workup of the patient. The frequent occurrence of an isolated late phase nasal response may make the correct diagnosis confusing. A site visit to the specific work area may give helpful insights to the patient's exposure. Greater objectivity to the diagnosis can be obtained through the rapidly developing technique of rhinomanometry.

CONCLUSION

The management of occupational rhinitis should include not simply pharmacotherapy but also environmental control measures. Through these means, patients may be spared the distress and discomfort of occupational rhinitis.

Systemic anaphylaxis after ingestion of a psyllium-containing breakfast cereal

Allergic reactions have been described as an occupational hazard among nurses and pharmaceutical workers who handle psyllium-containing laxatives. This study reports the case of a 38-year-old female nurse who ingested a bowl of psyllium-containing Heartwise Cereal (Kelloggs, Battle Creek, MI) and 25 minutes later developed severe systemic anaphylaxis manifested by hypotension, a feeling of constriction in the throat, hoarseness, dyspnea, wheezing, generalized pruritus, urticaria, and vomiting. She was treated with epinephrine, normal saline, diphenhydramine, and methylprednisolone, and recovered completely. Subsequent IgE immunoblot assay was strongly reactive to psyllium. Ingestion of psyllium-containing breakfast foods by sensitized individuals can be associated with life-threatening systemic anaphylaxis.