Development of resistance to eprinomectin in gastrointestinal nematodes in a goat herd with pre-existing resistance to benzimidazoles

We described a first case of resistance to eprinomectin in goat herd in Poland in which resistance to benzimidazoles had been previously reported. The herd was established in 2011 by purchasing several goats from a single herd in south-eastern Poland. Resistance to benzimidazoles in the herd was first reported in 2017. Shortly after the owner started to signal low effectiveness of the treatment with eprinomectin. In June 2018 the larval development test from pooled faecal sample was performed and the results indicated the presence of resistance to macrocyclic lactones and levamisole. In July 2018 a faecal egg count (FEC) reduction test was performed in 39 animals with levamisole, eprinomectin and one untreated control group. Drugs were used in doses recommended for goats. Three methods of calculation of FEC reduction were compared. After eprinomectin treatment, FEC reduction ranged from 0 to 20%, depending on the method of calculation. FEC reduction following levamisole treatment was 100%. Main species present in the faecal samples after treatment and in larvicidal concentrations in larval development test was Haemonchus contortus. This is the first report of anthelminthic resistance to macrocylic lactones (eprinomectin) in goats in Poland.

Expression analysis of three miRNAs, miR-26a, miR-29b and miR-519d, in relation to MMP-2 expression level in non-small cell lung cancer patients: a pilot study

Lung cancer is the most common cause of death in men and second only to breast cancer in women. MicroRNAs (miRNAs) are involved in tumorigenesis and function as oncogenes or tumor suppressor genes. Among other genes, miRNAs regulate matrix metalloproteinases (MMPs), the proteolytic enzymes playing a significant role in the degradation of extracellular matrix, enhancing tumor invasion and metastasis. The aim of the study was to evaluate the expression levels of selected miRNAs: miR-26a, miR-29b and miR-519d, and their target gene, matrix metalloproteinase-2 (MMP-2) in patients with non-small cell lung cancer (NSCLC). The results were correlated with tumor staging, NSCLC histopathological subtypes and patients' demographical features to assess the possible diagnostic/prognostic value of the studied miRNAs and MMP-2. Total RNA was isolated from 38 NSCLC tissue samples, and the expression analysis was performed using TaqMan(®) probes in qPCR assay. The results indicated underexpression of selected miRNAs and overexpression of MMP-2. The decrease in miRNA-29b expression was statistically significant and differentiated NSCLC histopathological subtypes. Additionally, statistically significant negative correlation was found between MMP-2 expression and its regulatory miR-26a. There are very few studies reporting miRNA-MMPs analysis on mRNA level in lung cancer, and no similar reports are available from Polish population. The results of our pilot study indicated the diagnostic potential of miR-29b and MMP-2, an inverse association between miR-26a and MMP-2, and proved the role of MMP-2 and the studied miRNAs in lung carcinogenesis. Further studies are needed to verify their potential usefulness for the treatment of lung cancer.

RARβ Promoter Methylation as an Epigenetic Mechanism of Gene Silencing in Non-small Cell Lung Cancer

The retinoid acid receptor-p (RARβ) gene is one of the tumor suppressor genes (TSGs), which is frequently deleted or epigenetically silenced at an early stage of tumor progression. In this study we investigated the promoter methylation and expression status of the RARβ gene in 60 surgically resected non-small cell lung cancer (NSCLC) tissue samples and 60 corresponding unchanged lung tissue samples, using methylation-specific PCR and real-time-polymerase chain reaction (qPCR) techniques. We correlated the results with the pathological features of tumors and clinical characteristics of patients. qPCR analysis detected a significantly lower RARβ expression in the patients with adenocarcinoma (AC) and large cell carcinoma (LCC) than in those with squamous cell carcinoma (SCC) (AC vs. SCC, p = 0.032; AC and LCC vs. SCC, p = 0.0 13). Additionally, significantly lower expression of the RARβ gene was revealed in the patients with non-squamous cell cancer with a history of smoking assessed as pack-years (PY < 40 vs. PY ≥ 40, p = 0.045). Regarding RARβ promoter methylation, we found significant differences in the methylation index in the SCC group when considering pTNM staging; with higher index values in T1a + T1b compared with T2a + T2b and T3 + T4 groups (p = 0.024). There was no correlation between the methylation status and expression level of the RARβ gene, which suggests that other molecular mechanisms influence the RARβ expression in NSCLC patients. In conclusion, different expression of the RARβ gene in SCC and NSCC makes the RARβ gene a valuable diagnostic marker for differentiating the NSCLC subtypes.

Expression of HIF-1A/VEGF/ING-4 Axis in Pulmonary Sarcoidosis

Angiogenesis/angiostasis regulated by hypoxia inducible factor-1A (HIF-1A)/vascular endothelial growth factor (VEGF)/inhibitor of growth protein 4 (ING-4) axis may be crucial for the course and outcome of sarcoidosis. Overexpression of angiogenic factors (activation of VEGF through HIF-1A) may predispose to chronic course and lung fibrosis, whereas immunoangiostasis (related to an overexpression of inhibitory ING-4) may be involved in granuloma formation in early sarcoid inflammation, or sustained or recurrent formation of granulomas. In this work we investigated gene expression of HIF-1A, VEGF and ING-4 in bronchoalveolar fluid (BALF) cells and in peripheral blood (PB) lymphocytes of sarcoidosis patients (n=94), to better understand mechanisms of the disease and to search for its biomarkers. The relative gene expression level (RQ value) was analyzed by qPCR. The results were evaluated according to the presence of lung parenchymal involvement (radiological stage I vs. II-IV), acute vs. insidious onset, lung function tests, calcium metabolism parameters, percentage of lymphocytes (BALL%) and BAL CD4+/CD8+ in BALF, age, and gender. In BALF cells, the ING-4 and VEGF RQ values were increased, while HIF-1A expression was decreased. In PB lymphocytes all studied genes were overexpressed. Higher expression of HIF-1A in PB lymphocytes of patients with abnormal spirometry, and in BALF cells of patients with lung volume restriction was found. VEGF gene expression in BALF cells was also higher in patients with abnormal spirometry. These findings were in line with previous data on the role of HIF-1A/VEGF/ING-4 axis in the pathogenesis of sarcoidosis. Up-regulated HIF-1A and VEGF genes are linked to acknowledged negative prognostics.

Detection of the DNA of Borrelia afzelii, Anaplasma phagocytophilum and Babesia canis in blood samples from dogs in Warsaw

Each month, from March 2003 to February 2004, 34 blood samples from dogs were randomly selected from the blood samples delivered to two veterinary laboratories in Warsaw and tested for the DNA of Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum, Babesia canis and Hepatozoon canis. Borrelia DNA was detected in seven of the 408 dogs, A phagocytophilum DNA was found in two, and B canis DNA was found in 48 (11.8 per cent). The DNA of H canis was not found in any of the blood samples. Sequencing of the seven Borrelia amplicons showed that only the genospecies Borrelia afzelii was present, the first time it has been detected in dogs in Poland.

Changes in the prevalence of parasitic nematode infections in dogs from animal asylums in Warsaw and sourroundings

The distribution of parasitic nematodes of dogs from three shelters for homeless animals in the Warsaw region (Celestynów and Milanówek near Warsaw, Paluch in Warsaw) was investigated. It was found that since our previous investigations (1993-1995) the prevalence of nematode infections had increased in Celestynów and Milanówek and decreased in the municipal shelter in Warsaw (Paluch). The highest percentage of infected animals was found in Celestynów (as in 1993-1995). What can be the importance of local environmental conditions for the prevalence of nematode infections.

New localities of Dermacentor reticulatus tick (vector of Babesia canis canis) in central and eastern Poland

Dermacentor reticulatus tick is a vector and final host of Babesia canis canis, protozoan parasite of the dog. In Poland and other European countries, endemic regions for canine babesiosis caused by B. canis canis are the same as endemic regions for D. reticulatus. In many of these regions, canine babesiosis is the most prevalent tick-borne disease in dogs. In Europe, increasing range of geographical distribution of D. reticulatus is observed. A consequence of this fact may be increasing range of canine babesiosis. D. reticulatus is one of the most common ticks occurring in Poland, however, it occurs mainly in the north-eastern and eastern part of the country, and there are many areas in which this species has not been reported yet. In this study, D. reticulatus ticks were collected from March 2007 to November 2008 in central and eastern Mazowsze region, and in some localities in Białystok and Lublin regions. Twenty four new sites for D. reticulatus, mainly in central and eastern regions of Mazowsze Province have been found. 18 localities are placed on banks of the fishing ponds or in river valleys and 6 are forests borders or barren lands and meadows, not situated near rivers or other water reservoirs. All tick-rich sites are localized in river valleys or on pond banks. However, statistical analysis showed that there were no differences in the density of ticks between groups of areas. These results show that the occurrence of D. reticulatus in newly detected areas has became endemic. Probably woodless, unregulated river valleys are important migration tracts for this species of tick and enable them to penetrate new territories. It seems likely that geographical range of D. reticulatus is widening from east to west of Poland what can induce an increase in the number of canine babesiosis cases in areas non-endemic for B. canis canis and its vector. Climate change may be also partially responsible for earlier beginning of tick's seasonal activity as well as for bigger faunal diversity (more potential host species both for adults and immature stages).

Genetic variants of FcepsilonRIbeta and Il-4 and atopy in a Polish population

BACKGROUND

Atopy results from the interaction between genetic and environmental factors. The aim of our study was to clarify the association between the FcRIint2 polymorphic variant, the Glu237Gly mutation in exon 7 of FcepsilonRIbeta and (-590 C/T) Il-4 gene promoter polymorphism with atopy in a randomized Polish sample.

SUBJECTS AND METHODS

Unrelated subjects aged 18-45 years who were residents of an urban area (Lodz, Poland) were included in the study: 98 patients with asthma and/or allergic rhinitis, and 87 non-atopic, non-asthmatic controls. We used common criteria for atopy and asthma. Atopic status was determined by positive skin prick tests (SPT) and IgE levels. The severity of asthma was assessed in spirometric measurements; SPTs to house dust mite (HDM) and mixed grass pollen (MGP) were performed. Total and specific IgE were measured in each subject. Genotypic analysis was performed by PCR for FcRIint2 and (590 C/T) Il-4 gene promoter polymorphism and ARMS-PCR was performed for the Glu237Gly mutation.

RESULTS

We found a statistically significant association between atopy and FcRIint2 variant polymorphism (OR = 2.96), a correlation between positive skin prick tests to MGP and raised MGP-specific IgE concentrations in patients bearing this variant (OR = 4.0). We did not observe that the FcRIint2 variant was associated with positive SPTs to HDM or high levels of HDM-specific IgE (OR = 1.0). The intronic variant of FcepsilonRIbeta was strongly correlated with elevated total serum IgE (OR = 4.74). No statistically significant association was found between atopy and the Glu237Gly mutation of FcepsilonRIbeta(OR = 1.36) or (-590 C/T) Il-4 gene promoter polymorphism (OR = 0.88).

CONCLUSIONS

The results suggest that FcRIint2 polymorphism is related to atopy and may influence its development.

Inhalations of 5-ALA in photodynamic diagnosis of bronchial cancer

Background: Photodynamic bronchoscopy (PDD) allows for early detection of bronchial cancer. Adverse effects and high costs, partly related to general application of photosensitisers, are important limitations of the method. The local application of a photosensitiser could help to minimize these problems. In this study the validity and safety of inhaled 5-ALA have been tested. Methods: We examined 49 patients (age 59±11, cigarette consumption 36±17 pack-years) with present or past respiratory neoplasms and other with increased risk of bronchial cancer by photodynamic bronchoscopy (Storz- D-light) after inhaled 5-ALA. Biopsies were taken from the fluorescence-positive and negative foci (control). Symptoms and pre-/post-inhalation spirometry were analysed. Results: The overall sensitivity was 82%, specificity 62%, positive predicted value (PPV) 45% and negative predictive value (NPV) 90%. Specificity decreased to 53% and PPV to 15% when visible tumours were excluded. PDD, when added to white light bronchoscopy increased sensitivity by 2.1% and NPV by 6%, but decreased specificity by 35.4% and PPV by 53.1%. In a group of actual or past tumours the sensitivity increased by 22% and NPV by 34%, whereas specificity decreased by 26% and PPV by 35%. In 2 cases a drop in FEV1 above 10% of pre-inhalation value was observed but no clinically relevant symptoms were reported. Conclusions: Photodynamic bronchoscopy with inhalation of 5-ALA is a relatively safe diagnostic method. The main disadvantage is high percentage of false positive results. Nevertheless, we believe, that it may be a useful adjunct to conventional diagnostic modes, especially in the detection of early lesions in patients operated due to cancer (stump control and detection of metachronous lesions) and those prepared for operation (synchronous lesions and detection of infiltration margins). However all suspected lesions must be verified by histo-pathological examination.

Respiratory allergy in apprentice bakers: do occupational allergies follow the allergic march?

BACKGROUND

This prospective study describes the incidence, risk factors and natural history of occupational respiratory allergy in apprentice bakers.

METHODS

Two hundred and eighty-seven apprentice bakers were examined using a questionnaire, skin prick tests (SPTs) to common and occupational allergens, evaluation of total serum IgE level and specific anti-flour and alpha-amylase IgE, before, 1 year and 2 years after the onset of vocational training. To diagnose occupational respiratory disease, spirometry, histamine and allergen-specific inhalation challenge tests were performed.

RESULTS

The incidence of work-related chest symptoms was 4.2% in the first year and 8.6% in the second year of exposure. Hypersensitivity to occupational allergens developed in 4.6 and 8.2% of subjects, respectively. The incidence of occupational allergic rhinitis was 8.4% after 1 year and 12.5% after 2 years, and that of occupational asthma/cough-variant asthma 6.1 and 8.7%, respectively. The latency period of work-related rhinitis symptoms was 11.6 +/- 7.1 months and chest symptoms 12.9 +/- 5.5 months. Only in 20% of occupational asthmatics could allergic rhinitis be diagnosed a stage earlier. In 21 out of 25 subjects with occupational asthma, chronic cough was the sole clinical manifestation of the disease. Stepwise logistic regression analysis revealed that positive SPT to common allergens was a significant risk factor of hypersensitivity to occupational allergens (OR = 10.6, 95% CI 5.27; 21.45), occupational rhinitis (OR = 3.9, 95% CI 1.71; 9.14) and occupational asthma (OR = 7.4, 95% CI 3.01; 18.04). Moreover, positive SPT to occupational allergens on entry to the training was a significant risk factor of asthma (OR = 6.9, 95% CI 0.93; 51.38).

CONCLUSIONS

The incidence of occupational asthma and rhinitis in apprentice bakers is high and increases z with the duration of exposure. Skin reactivity to common and occupational allergens is the main risk factor of bakers' asthma. Most cases of work-related respiratory symptoms among apprentice bakers are related to a specific sensitization. In most subjects who developed occupational asthma, rhinitis occurred at the same time as the chest symptoms did.

Montelukast plus cetirizine in the prophylactic treatment of seasonal allergic rhinitis: influence on clinical symptoms and nasal allergic inflammation

BACKGROUND

The aim of our study was to investigate effects of 6-week pretreatment of seasonal allergic rhinitis (AR) with cetirizine, and montelukast, alone and in combination. Antihistamine/antileukotriene treatment is effective in AR. Antihistamines may prevent AR symptoms while prophylactic activity of antileukotrienes remains unclear.

METHODS

Sixty AR patients, aged 18-35 years, were randomized to receive placebo, montelukast only, cetirizine only, or montelukast plus cetirizine, 6 weeks prior and 6 weeks after the beginning of grass pollen season. Mean self-recorded in-season symptom scores and mean weekly all-symptom scores were analyzed. In 31 patients, nasal lavages were performed before treatment, and at the end of the study, i.e. 12 weeks after the treatment initiation. Eosinophil and basophil counts, eosinophil cationic protein (ECP), and mast cell tryptase (MCT) levels were evaluated in lavage samples.

RESULTS

Combined montelukast/cetirizine pretreatment significantly reduced in-season symptom score for sneezing, eye itching, nasal itching, rhinorrhea, and congestion. Montelukast plus cetirizine were more effective than cetirizine alone in preventing eye itching, rhinorrhea, and nasal itching. Moreover, combined pretreatment with montelukast and cetirizine delayed appearance of AR symptoms. Eosinophil nasal lavage fluid counts were significantly increased during pollen season in placebo and montelukast-only groups. No differences were observed in basophil counts. The in-season ECP level was significantly increased in all groups except montelukast-plus-cetirizine group. In-season MCT levels were not increased.

CONCLUSION

Combined antihistamine and antileukotriene treatment started 6 weeks before the pollen season is effective in preventing AR symptoms and reduces allergic inflammation in nasal mucosa during natural allergen exposure.

The effect of recombinant interleukin-8 on eosinophils' and neutrophils' migration in vivo and in vitro

BACKGROUND

Interleukin-8 (IL-8) is a chemokine that causes chemotaxis of neutrophils, eosinophils and lymphocytes in vitro; however, its role as a chemoattractant in allergic inflammation is unclear. The objective of this study was to investigate the effect of nasal instillation of IL-8 on the influx of inflammatory cells.

METHODS

Twelve patients suffering from seasonal allergic rhinitis hypersensitive to grass pollens, with average age 30.1 +/- 2.67 years were challenged both with diluent for IL-8 and IL-8 on a subsequent day, in two phases: before the pollen season (unprimed mucosa) and during the season (primed mucosa). The number of neutrophils, eosinophils and myeloperoxydase (MPO) levels in the nasal fluid collected after IL-8 or placebo challenge were determined.

RESULTS

Challenge with IL-8 of primed nasal mucosa induced a significant influx of neutrophils (29 x 10(4) cells/ml at 0.5 h, 251 x 10(4) at 2 h and 334 x 10(4) at 3 h). Number of eosinophils in comparison with diluent challenge was not significant. There was no difference in MPO levels in the nasal lavage between IL-8 and diluent challenge of unprimed and primed mucosa. We did not find the relationship between MPO levels and the neutrophils number in the lavage (rank Spearman factor, RS = 0.258, P = 0.42).

CONCLUSION

We have demonstrated that IL-8 causes influx of neutrophils but not eosinophils into nasal mucosa in vivo. MPO level seems to be of little value as a marker of neutrophil influx into nasal mucosa.

Comparison of standard and modified SPT method

BACKGROUND

The aim of our study was to compare clinical significance and economical factors of commonly used standard skin prick tests (SPT) method with new, modified and more handy way of performing SPT.

METHODS

Twenty-one subjects [with an average age of 23 years (SD +/- 2.72)] with known sensitivity to examined allergen extracts were tested with histamine, negative control solution and standard allergen extracts (Allergopharma, Reinbeck, Germany). SPT were applied to the volar surface of randomly assigned forearm with two methods: standard technique using lancet needle to prick the epidermis under small drop of extract and tested method using lancet needle which was dipped in extract before prick. In this method all extracts were placed in marked, small, plastic chambers.

RESULTS

Mean wheal to histamine was 5.49 (standard method) and 5.01 (modified method). There was no statistical difference between the standard and modified method for size of wheal to histamine (P = 0.654) and to allergen extracts (n = 36, P = 0.824, Wilcoxon test). Economical analysis revealed that examined SPT technique is cheaper than standard method.

CONCLUSION

Examined method may be considered to be an alternative for performing SPT as it is safe, cheaper and more convenient than standard technique.

SUMMARY STATEMENT

Comparison of standard and modified SPT method revealed the new method to be more economical.

Eotaxin but not MCP-3 induces eosinophil influx into nasal fluid in allergic patients

BACKGROUND

Eotaxin and MCP-3 (CC chemokines), owing to their preferential action on eosinophils, seem to be the very importance in the patophysiology of allergic rhinitis and asthma. The purpose of this study was to examine the effect of intranasally administered eotaxin and MCP-3 after specific allergen priming on the influx of inflammatory cells and their soluble mediators into the nasal mucosa.

METHODS

Eotaxin and MCP-3 have been applied intranasally at the increasing doses of 1, 5 and 10 microg to allergic patients after allergen priming. The 'nasal pool' technique was used. The cell count and biochemical parameters in nasal lavage were evaluated before 30 min, and 4 and 24 h after the challenge with chemokines.

RESULTS

Both eotaxin and MCP-3 induced the increase in clinical 'score' lasting till 24 h. Eosinophil influx into nasal mucosa after provocation with eotaxin was also observed. The challenge with MCP-3 did not induce any significant changes in nasal lavage fluid.

CONCLUSIONS

Eotaxin is likely to play an important role in the pathogenesis of allergic conditions in humans. MCP-3 did not induce inflammatory cell influx into nasal mucosa. The role of this chemokine in the pathogenesis of allergic inflammation is difficult to assess and requires further studies.

[Natural history of occupational allergy to latex in health care workers]

The analysis of natural history of allergy to natural rubber latex (NRL) in health care workers, including the influence of exposure cessation on the clinical status and objective allergy markers was the objective of the study. The study covered 58 patients with recognised allergy to NRL. Of this number, 26 were followed up for 2 years after diagnosing NRL allergy. Medical examination, skin prick tests for common allergens and NRL, determination of total serum IgE and NRL-specific IgE antibodies, rest spirometry and non-specific bronchial hyperactivity test with histamine were performed. The retrospective analysis of clinical manifestation of NRL allergy revealed in 36% of patients progression of symptoms from local urticaria and rhinitis to systemic reactions. Two years after the cessation of exposure to NRL, symptoms became less severe in the majority of patients and even a clearance of allergic symptoms was observed, as well as the decrease in doses of inhalative glicocorticosteroids was noted. This was accompanied by the decline in non-specific bronchial hyperactivity. Although the skin prick tests showed the tendency to remain positive, the decrease in the level of specific anti-NRL IgE was found in 10 patients (including the RAST negativisation in one case). In conclusion, clinical progress from NRL-induced contact urticaria and allergic rhinitis to systemic reactions was observed only in part of patients with NRL allergy, which cannot be taken as a rule. Significant reduction of clinical symptoms or even total remission of NRL-allergic symptoms could be observed after exposure cessation.

Occupational asthma and rhinitis due to glutaraldehyde: changes in nasal lavage fluid after specific inhalatory challenge test

BACKGROUNDd: Glutaraldehyde (GA) is a known respiratory sensitizers, and some studies have reported occupational asthma in exposed workers. Specific changes in nasal lavage fluid (NLF) induced by high-molecular-weight allergen provocation in sensitized subjects were described previously. The purpose of this study was to evaluate the changes in cytogram, protein content, eosinophil cationic protein (ECP), and mast-cell tryptase concentrations in NLF after GA inhalation challenge in patients with a positive history of GA-induced asthma and late or dual asthmatic response due to exposure to low-level GA.

METHODS

A single-blind, placebo-controlled study was performed on 11 health workers with occupational asthma and rhinitis due to GA. The control groups comprised 10 atopic subjects with perennial asthma and rhinitis and 10 healthy ones. A "nasal pool" technique was used to evaluate the examined parameters in nasal washings before and 30 min, 4 h, and 24 h after the inhalatory provocation with GA and placebo.

RESULTS

There was a significant increase in eosinophil number and percentage, and albumin, ECP, and tryptase concentrations in NLF from patients with occupational asthma and rhinitis when compared to controls.

CONCLUSIONS

The results indicate the immunologic mechanism of GA-induced asthma and the applicability of the "nasal pool" technique as the diagnostic procedure in GA-induced airway allergy.

Nasal and bronchial responses to flour-inhalation in subjects with occupationally induced allergy affecting the airway

OBJECTIVES

The aim of the study was to follow the similarities and differences, of cellular and mediator changes and mucosal/vascular permeability in the upper and lower airway after specific and nonspecific bronchial provocation, in bakers with diagnosed occupationally induced allergy affecting the airway. In addition, the authors try to find whether there is a relationship between cellular changes in nasal and bronchoalveolar lavage, and bronchial hyperreactivity.

METHODS

The study participants were 10 bakers with occupational bronchial asthma and allergic rhinitis. All patients were sensitized to investigated allergen-flour. Nasal- and bronchoalveolar lavage techniques were used to evaluate the changes of the cellular and mediator response (tryptase, eosinophil cationic protein, ECP) and albumin level after specific (flour) and placebo provocation. In addition. bronchial hyperreactivity for histamine, and forced expiratory volume in 1 s (FEV1) were measured after the challenge.

RESULTS

There was a significant increase in the percentage of eosinophils, basophils and albumin in nasal and bronchoalveolar lavage of occupationally sensitized bakers. A statistically significant increase in the percentage of neutrophils in bronchoalveolar lavage was observed only 24 h after the allergen challenge. The level of tryptase in nasal lavage was significantly higher during the early allergic response. The levels of ECP in both nasal and bronchoalveolar lavage were significantly increased during the late allergic response. There were also severe bronchial reactions and increase of bronchial hyperreactivity for histamine in occupationally sensitized bakers in the late phase of allergic reaction.

CONCLUSION

Eosinophils and basophils proved to be the predominant cells in nasal and bronchoalveolar lavage of patients with occupationally induced bronchial asthma and rhinitis. The prolonged increase of albumin level seems also to be a good predictor of protracted nasal and bronchial inflammation. The results obtained confirmed that tryptase and ECP are good markers for monitoring mast cell and eosinophil degranulation during the allergic reaction. Increase of airway responsiveness reflects an eosinophil and basophil contribution to airway allergic response.

[Nephropathy in the course of inflammatory connective tissue diseases]

The aim of the study was to assess the frequency of renal complications and also evaluation of renal efficiency with regard to sex and age in children with inflammatory connective tissue diseases. The examination embraced 18 children out of 5657 hospitalised in 19991-1998 in Military University School of Medicine-Dpt of Pediatrics suffering from inflammatory connective tissue diseases, which constitutes 0.32%. They found the following number of isolated cases: 9 cases of juvenile chronic arthritis (JCA), 6 cases of rheumatic fever (RF), and 3 cases of systemic lupus erythematosus (SLE). There were 9 girls and 9 boys. The most frequent symptom of kidneys affection was erythrocyturia. Due to chronic course, reccurrence and the possibility of further complications, children with inflammatory connective tissue diseases, after discharging from hospital, should stay under the care of rheumatological outpatient clinic.

[Nephropathy in the course of Schönlein-Henoch purpura]

The aim of the study was to assess the frequency of renal complications and also evaluation of renal efficiency with regard to sex and age in children with Schonlein-Henoch purpura. 31 children with Schonlein-Henoch disease out of 5004 hospitalised in 6 years time (1994-1999) in Mil. Medical University-Dpt of Pediatrics, underwent the examination, which is 0.62% of all patients. The group of analysed cases consisted of 19 girls (61.3%) and 12 boys (38.7%). 15 of them had changes in kidneys, which constitutes 48.4%. The average age of examined children was 9.1 years. In the most cases upper respiratory tract infections preceded symptoms of the Schonlein-Henoch purpura. The most often complications found in the course of the Schonlein-Henoch purpura were renal ones. The most numerous renal complications affected children between 7 and 9 years of age. Because of chronic and insidious course of the disease, children, after discharging from hospital should stay under specialistic medical care.

Problems in diagnosing occupational allergy to flour: results of allergologic screening in apprentice bakers

Baker's respiratory allergy is reported as one of the most common forms of occupational allergy in many countries. At the first stage of a three-year study of risk factors of occupational allergy we investigated the symptoms reported, and the results of skin prick tests (SPT) to common and flour allergens in 461 current apprentice bakers from three different regions of Poland before starting occupational exposure. The occurrence of cough was reported by 14 subjects (3%), dyspnoea by 4 (0.87%), rhinitis by 18 (3.9%), conjunctivitis by 12 (2.6%) and skin symptoms by 12 subjects (2.6%). Generally, 48 subjects (10.41%) reported at least one symptom, which might suggest the existence of allergic disease. Positive SPT to at least one allergen was found in 99 subjects (21.5%), including 82 subjects (17.78%) with positive SPT to common allergens, 13 subjects (2.81%) to flour allergens and 4 subjects (0.88%) sensitised only to Dermatophagoides farinae. The statistical analysis revealed significant correlation between positive SPT to common allergens and reported rhinitis and conjunctivitis, and between positive SPT to occupational allergens and reported dyspnoea. Moreover, a significant correlation between positive SPT to D. pteronyssinus and D. farinae was found. In our opinion, the results of SPT should be very carefully examined, when diagnosing occupational allergy, as in some apprentice bakers positive results of SPT to flour allergens are found before vocational training. In all apprentice bakers, SPT to common and occupational allergens should be performed before starting occupational exposure. It would ensure the exclusion of subjects already sensitised to occupational allergens. Positive SPT to Dermatophagoides farinae has a very limited value in recognising baker's allergy.

[Cyclic vomiting with ketosis as a cause of acute kidney dysfunction: own clinical experience]

The aim of the study was to evaluate renal activity during cyclic vomiting with ketosis. The clinical material was obtained from 50 cases of children hospitalized in Department of Pediatrics Military Medical University within 1993-1999 what makes about 1% of all patients. The examined group consisted of 26 boys (52%) and 24 girls (48%). Three of the children were repeatedly hospitalized (3 to 8 times) because of acetonemic vomiting. The special attention during the laboratory studies was paid to evaluation of renal activity. Vomiting with ketosis were associated with temporary kidneys acute dysfunction in 46% of cases. In 98% of cases the parenteral hydration was necessary. Ketonemic vomiting with kidneys dysfunction was observed mainly with the children in pre-school age.

Allergy to laboratory animals in children of parents occupationally exposed to mice, rats and hamsters

Sensitization to laboratory animals (LA) has a high prevalence among laboratory workers. It is unknown whether transportation of LA allergens can be a risk factor for sensitization of subjects outside the laboratory environment. The aim of the study was to investigate the prevalence of sensitization to LA among children whose parents were and were not occupationally exposed to LA. The first group consisted of 50 children (age 12.3+/-4.3 yrs) whose parents were occupationally exposed to mice, rats and hamsters. The second group consisted of 40 children (age (mean+/-SD) 10.8+/-3.0 yrs) whose parents were not occupationally exposed to LA. Children having LA at home were eliminated from the study. All children responded to a questionnaire, underwent spirometry and were also tested with skin prick tests with the use of common allergens and prick tests with hair extracts from mouse, hamster and rat. Total immunoglobulin (Ig)E levels and the presence of specific IgE against LA were also estimated. Children of parents occupationally exposed to LA presented significantly more positive skin prick tests against allergens from the hair of laboratory animals compared to children of nonexposed parents. Five children from the first group were also found to have specific IgE against LA, with three of these five children complaining of rhinitis and cough while visiting their parents' workplace. It is concluded that the observed increased sensitization to laboratory animals among children of occupationally exposed parents could be the result of poor hygienic conditions at their parents' workplace. Hence, parents' job seems to be an additional risk factor of sensitization and should be taken into consideration when recording an allergic history.

Analysis of the clinical state of patients with occupational asthma following cessation of exposure to allergens

The purpose of this study was to evaluate the health state of patients with occupational asthma after cessation of occupational exposure to bakery allergens. A follow-up study of 56 subjects with occupational asthma was carried out. Subjects were examined twice: 1-6 months after removal from occupational exposure and 36 or 48 months later. Clinical state analysis both at diagnosis and re-examination was performed with the use of a questionnaire. Functional spirometric tests and skin prick tests and/or specific serum IgE were carried out during both examinations at points of time at which the subjects regarded their asthma symptoms as least severe. According to the subjective evaluation of the patients' clinical state, some improvement could be noticed 36 or 48 months after removal from work. Forced expiratory volume in one second (FEV1) and peak respiratory flow (PEF) did not change significantly. Total serum IgE concentration decreased in only two subjects, but the mean value of total IgE level did not significantly differ at the first and second examination after the cessation of occupational exposure. There was no significant difference in the number of positive skin prick tests to common and occupational allergens between the first and second examination. The majority of patients with occupational asthma reporting subjectively on their symptoms indicated an improvement in their clinical state 2-3 years after removal from occupational exposure. The intensity of skin prick tests was not reduced in the studied group. Non-specific bronchial hyper-responsiveness was not reduced in the majority of subjects with occupational asthma at least 2 years after cessation of occupational exposure.

Latex allergy in Polish nurses

BACKGROUND

Reports on the studies conducted in Western Europe and North America revealed that from 2.8 to 16.9% of the health care personnel were allergic to latex. No respective data are available from Eastern European countries.

METHODS

A postal questionnaire inquiring about the history of latex-induced allergic reactions was distributed among 3,750 nurses. The participation rate was 77.3%. To verify the results of the survey, in randomly selected nurses, skin prick tests with latex and tropical fruit allergens, evaluation of total IgE, and specific anti-latex IgE, skin and nasal provocation with latex were performed.

RESULTS

Allergic symptoms in the workplace were reported by 1,016 subjects (35%); out of this group 847 (29.2%) persons associated the symptoms with latex exposure. The group of cases with self-reported latex allergy revealed a significantly increased frequency of history of atopy, allergy to beta-lactam antibiotics and tropical fruits. Allergy to latex was confirmed in 33.3% of randomly selected nurses with a positive history of occupational allergy. It was found that 18.6% of nurses working at hospital wards were allergic to latex. The 95% CI was estimated to be 13.5-23.6%.

CONCLUSIONS

Latex allergy is an important health problem among nurses in Poland. Atopy, allergy to beta-lactam antibiotics and tropical fruits, are the risk factors for latex allergy.

Comparison of cardiac response to managerial workload between men and women

The aim of the study, was to estimate the reaction of selected circulatory system parameters to psychic workload in industrial managers and to answer the question whether may affect this reaction. The study was performed in 23 men (mean 46 +/- 6 years of age) and 16 women (mean 42 +/- 6 years of age), employed as executives in a large industrial plant. The subjects had their 24-h ECG recorded using Medilog 3000 (Oxford). The ECG recordings were classified as pathological according to the standards of Bjerregaard. Heart rate was calculated for working time, leisure time and sleep. The subjects were also asked to estimate the perceived psychic load according to a method involving subjective estimation of work-demands and of an ability to cope with them. Generally, the subjects reported high work demands, but coping abilities were higher than work demands. Both in the men and women, a relationship was found between the intensity of subjective estimation of psychic load and heart rate response. However, the reaction of the circulatory system to the psychic workload in men was long-lasting (its effects continued until late at night); in women it was more direct (only during work). The frequency of abnormalities in 24-h Holter ECG recordings for both test groups was not very high, a little higher in men (30%) than in women (25%), and was comparable with the frequencies in selected general population groups. Our results may indicate that mental workload of the managerial staff, does not cause increased frequency of ECG abnormalities. However, in view of the fact that cardiovascular diseases are more frequent among men than among women, different reaction of the circulatory system to workload should also be accounted for in an attempt to explain the sources of that phenomenon.

[Allergic conditions for diseases of the respiratory tract from occupational exposure to acid anhydrides]

Acid anhydrides are highly reactive, low molecular weight compounds that are used widely in industry. Work-related exposure to this group of substances may cause occupational asthma. Because of low molecular weight, these compounds are not able to induce antibody responses without conjugating with human proteins. Acid anhydrides may act as haptens when conjugated with human serum albumin (HSA). The induction mechanism of immediate and late bronchial hyperresponsiveness to acid anhydrides appears to be at least partly mediated by IgE antibodies. Other clinical syndromes, which may be caused by acid anhydrides such as pulmonary disease-anemia (PDA), and late respiratory systemic syndrome (LRSS) associated with TMA exposure, appear to be associated with IgG antibodies to TMA as well as with IgE. Significant cross-reaction occurs between different compounds of this group, particularly regarding IgE antibodies. As inhalational exposure to acid anhydrides may result in serious pulmonary disease, adequate protection of potentially exposed workers or their removal, if affected, from exposure is essential.

Occupational allergy to latex--life threatening reactions in health care workers. Report of three cases

During the last decade natural rubber latex (NRL) allergy has been acknowledged as a major problem among rubber glove-wearing medical personnel. Epidemiological studies carried out in the European Union member states as well as in the United States reveal that 2% to 15% of health care workers are allergic to latex. Latex allergy symptoms range from mild contact urticaria to severe systemic reactions. Serious, generalised reactions occur in 6-8% of patients allergic to latex. The risk factors for latex-induced anaphylaxis have not as yet been identified. NRL allergy symptoms may occur in the workplace as well as outside the occupational environment. The authors present clinical cases of 2 nurses and 1 laboratory worker, who developed severe allergic reactions to latex: case 1--during prophylactic gynaecologic examination, case 2--in the course of inhalative bronchial challenge test with latex aqueous extract and case 3--while blowing up balloon at home.

Airway response to formaldehyde inhalation in asthmatic subjects with suspected respiratory formaldehyde sensitization

The aim of the study was to characterize the mechanism of formaldehyde (FM)-induced nasal and bronchial response in asthmatic subjects with suspected FM allergy. Ten subjects purported to have FM rhinitis and asthma and 10 healthy subjects submitted to an inhalation provocation in an exposure chamber with FM at a dose of 0.5 mg/m3 over 2 hr. Spirometry at rest and following bronchial provocation with histamine (PC20) were recorded before and after FM inhalation. In addition, FM-specific serum IgE antibodies were measured and cellular, biochemical, and mediator changes were assessed in nasal lavage before, and immediately after, provocation and at 4 hr and 24 hr later. Provocation with FM caused only transient symptoms of rhinitis in both groups. None of the subjects supposed to have occupational asthma developed clinical symptoms of bronchial irritation. No specific IgE antibodies to FM were detected in persons with occupational exposure to FM. No differences in the nasal response to FM were found between subjects reporting to have occupational allergic respiratory diseases and healthy subjects (P > 0.05). In summary, inhaled formaldehyde at a level as low as 0.5 mg/m3 did not induce a specific allergic response either in the upper or in the lower part of the respiratory tract. Moreover, there is no difference in nasal response to FM in asthmatic subjects occupationally exposed to FM and healthy subjects.

Nasal challenge test in the diagnosis of allergic respiratory diseases in subjects occupationally exposed to a high molecular allergen (flour)

The objective of this study was the evaluation of the usefulness of the nasal challenge test in the diagnosis of allergic respiratory diseases in subjects occupationally exposed to flour. A single-blind, placebo controlled study was conducted in 100 subjects with occupational atopic asthma with rhinitis. The control groups consisted of 20 atopic subjects not sensitized to investigated allergens and 20 healthy subjects. A 'nasal pool' technique was used to evaluate the changes of the cellular response and protein level in nasal washings after topical provocation with allergen or placebo. The concentrations of eosinophil cationic protein and mast cell-derived tryptase in nasal fluid were evaluated in 60 cases. There were significant increases in eosinophil and basophils number, albumin/total protein ratio, eosinophil cationic protein and tryptase levels in occupationally sensitized patients challenged with specific allergens. There were neither severe bronchial reactions or an increase of bronchial hyperreactivity in occupationally sensitized patients after the nasal provocation with flour. The nasal challenge test appears to be a very useful and safe tool for diagnosing occupational allergy.

Occupational respiratory diseases in laboratory animal workers: initial results

Laboratory-animal allergy (LAA) is a well-known occupational hazard to workers employed in biological or medical research institutes and in the pharmaceutical industry. The aim of this study was to focus on the problem of LAA and to assess factors predisposing to sensitization among subjects occupationally exposed to animals. Sixty workers were examined in our study. They responded to a questionnaire and underwent spirometry (Vital Capacity, VC and Forced Expiratory Volume in one second, FEV1). In addition, Peak Expiratory Flow (PEF) and the histamine provocation test were estimated in 5 subjects that had been hospitalized in the Department of Occupational Diseases. Skin prick tests with common allergens and with hair extracts from laboratory animals were performed, and total IgE levels and specific IgE antibodies were also measured. Among 60 subjects who had been working with animals, 26 had positive skin prick tests for one or more of the common allergens. Five subjects supposed to have occupational bronchial asthma and four with occupational allergic rhinitis showed positive skin prick tests for one or more animal allergens, increased total IgE levels and specific serum IgE antibodies. All these subjects had smoked for years.

CONCLUSIONS

1) Laboratory animal allergy develops within first years of exposure; 2) atopy and smoking predispose to laboratory animal sensitization and to a development of bronchial asthma and allergic rhinitis.

Occupational rhinitis and bronchial asthma due to morphine: evidence from inhalational and nasal challenges

A case of occupational bronchial asthma due to morphine in a nonatopic 46-year-old woman is presented. The following diagnostic tests were used: a workplace trial with bronchodilator and placebo, and single-blind, placebo-controlled nasal and bronchial challenge with 0.5% morphine HCl. For the nasal challenge, four asthmatic patients were selected as a control group. The nasal washings were done before and 30 min, 3 h, 24 h, and 48 h after all challenges. In the nasal lavage fluid, the total numbers of eosinophils, neutrophils, basophils, and mast cells were counted, and, after the nasal challenge, total protein and albumin levels were measured. During the workplace trial, the PEF variability ratio increased from 5% to 38%. After the challenges, a decrease in the spirometric parameters (VC and FEV1) of about 30-40% was observed, with minimums at 24 and 48 h. An influx of granulocytes with an increase in the relative number of eosinophils and basophils from 3 h until 48 h after the challenge was observed in the nasal lavage fluid. The protein level in the nasal lavage fluid increased from 190 to 1275 microg/ml 24 h after the challenge with an increase of relative albumin level from 24% to 40% at 24 h. In the control group, no changes in relative number of basophils and eosinophils and albumin/total protein ratio in the nasal lavage fluid or in the spirometric parameters were observed after the challenge.

Nasal response to allergen challenge in patients with immediate asthmatic reaction

Ten patients with bronchial asthma and allergy to house-dust mite (HDM) and ten normal, nonatopic control subjects underwent a bronchial challenge with flour. Before and 24 hr after the allergen provocation with flour, the levels of eosinophil cationic protein (ECP) and myeloperoxidase (MPO) were determined in the serum and nasal lavage fluid. All allergics showed an isolated immediate asthmatic reaction (IAR). After the flour challenge only in asthmatic patients the increase was detected in the mean values of: 1) eosinophils (mean value before 16.7 x 103/mm3; mean after: 10 min 132.9 x 103/ml; 3 hr 183.6 x 103/mm3; 24 hr 110.6 x 103/mm3, p < 0.05), 2) basophils (mean before 1.2 x 103/mm3; mean after: 10 min 5.3 x 103/ml; 3 hr s 14.1 x 103/mm3 24 hr was 18.3 x 103/mm3, p < 0.05), 3) neutrophils (mean before 9.2 x 103/mm3; mean after 24 h 18.2 x 103/mm3, p < 0.05) in the nasal lavage fluid. In contrast to a group of normal subjects, asthmatics were found to have higher postchallenge levels of ECP and MPO in the nasal secretions as compared with the prechallenge levels (ECP-mean 3.85 ug/l compared with 32.17 ug/l, p < 0.05; MPO-mean 120-02 ug/l compared with 1313.2 ug/l, p < 0.05). The authors did not find any significant difference between pre- and postchallenge levels of ECP and MPO in the serum of asthmatics and controls. The higher levels of MPO as well as higher count of neutrophils observed in asthmatic patients 24 hr after allergen challenge support the neutrophil involvement in the allergic inflammation. Our results indicate that both neutrophils and eosinophils take part in allergic reaction in the mucosa.

Nasal response to allergen challenge in patients with immediate asthmatic reaction

Ten patients with bronchial asthma and allergy to house-dust mite (HDM) and ten normal, nonatopic control subjects underwent a bronchial challenge with flour. Before and 24 h after the allergen provocation with flour, the levels of eosinophil cationic protein (ECP) and myeloperoxidase (MPO) were determined in the serum and nasal lavage fluid. All allergics showed an isolated immediate asthmatic reaction (IAR). After the flour challenge only in asthmatic patients the increase was detected in the mean values of: 1/eosinophils (mean value before 16.7 x 10(3)/mm3; mean after; 10 min 132.9 x 10(3)/ml; 3 hr 183.6 x 10(3)/mm3; 24 h 110.6 x 103/mm3, p < 0.05), 2/basophils (mean before 1.2 x 10(3)/mm3; mean after: 10 min 5.3 x 10(3)/ml; 3 h s 14.1 x 10(3)/mm3 24 h was 18.3/mm3, p < 0.05), 3/neutrophils (mean before 9.2 x 10(3)/mm3; mean after 24 h 18.2 x 10(3)/mm3, p < 0.05) in the nasal lavage fluid. In contrast to a group of normal subjects, asthmatics were found to have higher postchallenge levels of ECP and MPO in the nasal secretions as compared with the prechallenge levels (ECP-mean 3.85 ug/l compared with 32.17 ug/l p < 0.05; MPO-mean 120.02 ug/l compared with 1313.2 ug/l, p < 0.05). The authors did not find any significant difference between pre- and postchallenge levels of ECP and MPO in the serum of asthmatics and controls. The higher levels of MPO as well as higher count of neutrophils observed in asthmatic patients 24 h after allergen challenge support the neutrophil involvement in the allergic inflammation. Our results indicate that both neutrophils and eosinophils take part in allergic reaction in the mucosa.

[Laboratory animals as a cause of occupational allergy]

Animal allergens are the strongest occupational allergens which sensitize the respiratory tract. Allergy to the animal is the most important occupational health hazard among people working with experimental animals in university and other research laboratories. The most common manifestations of allergy to laboratory animals are: bronchial asthma, rhinitis, contact urticaria, angioedema and contact dermatitis. The major source of allergen is the excreta and secreta of such animals as: rat, mouse, guinea pig, rabbit, dog, cow and horse. Among risk factors responsible for the development of animal allergy are: atopy, tobacco smoking and allergy to domestic pets. The diagnosis of laboratory animal allergy is usually based on a medical history. The objective evidence to support the diagnosis can be obtained from skin testing, a specific immunologic response and work related changes in peak flow rate. Reduction in the airborne levels of animal allergens not only at home, but also at work (proper ventilation, filter masks, elimination of domestic animals) and reduction of factors responsible for the development of bronchial hyperreactivity (avoidance of smoking), can contribute to decreasing the incidence of diseases.

Somatic antigens of adult Dicrocoelium dendriticum recognised by bile antibodies of naturally infected cattle

Bile samples, from slaughtered cattle harbouring between 120 and 280 adult lancet flukes, were used to investigate the range of somatic proteins inducing local antibody responses in naturally infected animals. Lancet fluke infections induced local (bile) antibody responses against Tris-buffered saline (TBS) soluble, sodium dodecyl sulphate (SDS) soluble and 2-mercaptoethanol (2-Me) soluble somatic proteins of adult Dicrocoelium dendriticum. IgA antibody isotypes predominated in the response against buffer-soluble somatic antigens, whereas SDS-soluble and 2-Me-soluble proteins induced similar level of both IgA and IgG1 antibodies. Analysis of the antigens recognised by particular isotype-specific bile antibodies suggests that different antigens preferentially induce isotype restricted antibody responses. The bile antibody response was highly species specific, only one antigen from somatic protein extracts of Fasciola hepatica being precipitated by bile samples showing the highest reactivity against D. dendriticum.