A possible unexpected link: Could wheat elimination trigger food protein-induced enterocolitis syndrome in a celiac disease patient?

Cases of association between celiac disease and wheat allergy have been described in the literature. However, to date, no reported cases have linked celiac disease with wheat food protein-induced enterocolitis syndrome (FPIES). We report a case of this association. A child diagnosed with celiac disease at the age of 2 years, following a gluten-free diet, experienced uncontrollable vomiting, and subsequent hypotension within 2 h of accidental ingestion of wheat flour. As a result, the child required hospitalization for fluid therapy. A similar episode occurred when the child turned 5 y, again resulting from accidental gluten ingestion. This time, the symptoms included vomiting, hypotension, and a loss of consciousness, leading to hospitalization for rehydration treatment. After this second episode, on suspicion of FPIES, the patient was referred to the pediatric allergists, who confirmed the diagnosis. To our knowledge, this is the first case of an association between celiac disease and FPIES. It has been hypothesized that exclusion diets in food-allergic children may lead to an increase in specific immunoglobulin E levels for those foods and, consequently, the risk of anaphylaxis. However, FPIES is not an immunoglobulin E-mediated condition. Hence, further investigations are warranted to elucidate the underlying mechanisms linking these 2 disorders.

Assessment of olfactory function by Sniffin' sticks in bakery workers exposed to flour dust

OBJECTIVE

This study used the Sniffin' Sticks test battery to evaluate olfactory function in employees of a bakery exposed to flour dust.

SUBJECTS AND METHODS

The study enrolled 43 individuals with exposure (i.e., to flour) plus 41 healthy volunteers as controls. Olfactory function was assessed in these subjects through the use of the Sniffin' Sticks test battery. The overall score was calculated by adding up the scores for each of the 12 separate odors. A score of 6 or less was deemed anosmia, from 7 to 10 hyposmia, and a score of 11 or 12 was taken to indicate no impairment of olfaction.

RESULTS

There was a statistically significant difference between the scores obtained in the exposure group (10.09±2.29) and the control group (10.73±2.07), the exposure group having a lower score (p<0.05). Within the exposure group, men and women did not score differently (p>0.05). Furthermore, in this group, the overall score did not correlate significantly with age, sex, length of employment, or use of tobacco or alcohol use (p>0.05). Using the scheme employed in this study, 9.3% of the exposed workers were anosmic, compared to 9.8% in the controls, whereas 34.9% of baker workers were hyposmic, compared to just 14.6% of the controls. Thus, our study shows that impairment of the ability to smell was present in 44.2% of individuals exposed occupationally to flour dust.

CONCLUSIONS

This study reveals that being exposed to flour dust reduces the ability to smell normally. In order to minimize the impact of being exposed, workplaces should ensure adequate ventilation and provide workers with protective facemasks.

Tyrophagus putrescentiae group 4 allergen allergenicity and epitope prediction

INTRODUCTION AND OBJECTIVES

Allergen-specific immunotherapy (ASIT) is the only allergic disease-modifying therapy available for children and adults, and recombinant allergens are an interesting approach to improve allergy diagnosis and ASIT. Tyrophagus putrescentiae is a common storage mite that produces potent allergens. The aim of this study was to express and characterize recombinant group 4 allergen protein of T. putrescentiae (Tyr p 4), and to further investigate allergenicity and potential epitopes of Tyr p 4.

MATERIALS AND METHODS

The cDNA encoding Tyr p 4 was generated by RT-PCR and subcloned into pET-28a(+) plasmid. The plasmid was then transformed into E. coli cells for expression. After purification by nickel affinity chromatography and identification by SDS-PAGE, recombinant Tyr p 4 protein was used for a skin prick test and an ELISA to determine the allergic response.

RESULTS

Study participants' allergic response rate to Tyr p 4 protein was 13.3% (16/120). Eight B-cell epitopes and three T-cell epitopes of Tyr p 4 were predicted.

CONCLUSIONS

Similar to group 4 allergens of other species of mite, allergenicity of Tyr p 4 is weak. The expression, characterization and epitope prediction of recombinant Tyr p 4 protein provide a foundation for further study of this allergen in the diagnosis and ASIT of storage mite allergy.

HOW to make a mix of low glycemic index flours for a good Neapolitan pizza for patients with diabetes

BACKGROUND AND AIMS

Our recent data document that a low glycemic index (LGI) Neapolitan pizza prepared with a mix of Kamut and whole wheat flours plus Glucomannan, (i) has a lower impact on postprandial hyperglycemic spikes than pizza made of whole wheat flour, (ii) is pleasant and appreciated as traditional one and (iii) does not cause any gastro-intestinal troubles. The aim of our study was to describe the validation process underlying the identification of the right mix of those elements for a LGI pizza preventing gastro-intestinal disturbances.

METHODS

we described all procedures followed to make good products with different combinations of the three components and a series of tests made by four well-experienced professional pasta-making masters, one nutritionist, five diabetologists, one nurse and twenty volunteers with T1DM.

RESULTS

we could identify the best workable and most suitable flour mix to achieve both pleasant taste and low glycemic impact proving to be efficient in real-life twin paper providing results from diabetic patients.

CONCLUSIONS

this kind of food will certainly help people with diabetes eat pizza without risking any serious deterioration of their own glucose control while fully enjoying socially active life.

A multicenter, randomized controlled comparison of three renutrition strategies for the management of moderate acute malnutrition among children aged from 6 to 24 months (the MALINEA project)

BACKGROUND

The aim of this open-label, randomized controlled trial conducted in four African countries (Madagascar, Niger, Central African Republic, and Senegal) is to compare three strategies of renutrition for moderate acute malnutrition (MAM) in children based on modulation of the gut microbiota with enriched flours alone, enriched flours with prebiotics or enriched flours coupled with antibiotic treatment.

METHODS

To be included, children aged between 6 months and 2 years are preselected based on mid-upper-arm circumference (MUAC) and are included based on a weight-for-height Z-score (WHZ) between - 3 and - 2 standard deviations (SD). As per current protocols, children receive renutrition treatment for 12 weeks and are assessed weekly to determine improvement. The primary endpoint is recovery, defined by a WHZ ≥ - 1.5 SD after 12 weeks of treatment. Data collected include clinical and socioeconomic characteristics, side effects, compliance and tolerance to interventions. Metagenomic analysis of gut microbiota is conducted at inclusion, 3 months, and 6 months. The cognitive development of children is evaluated in Senegal using only the Developmental Milestones Checklist II (DMC II) questionnaire at inclusion and at 3, 6, and 9 months. The data will be correlated with renutrition efficacy and metagenomic data.

DISCUSSION

This study will provide new insights for the treatment of MAM, as well as original data on the modulation of gut microbiota during the renutrition process to support (or not) the microbiota hypothesis of malnutrition.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT03474276 Last update 28 May 2018.

Balkan endemic nephropathy: an update on its aetiology

Balkan endemic nephropathy (BEN) is a unique, chronic renal disease frequently associated with upper urothelial cancer (UUC). It only affects residents of specific farming villages located along tributaries of the Danube River in Bosnia-Herzegovina, Croatia, Macedonia, Serbia, Bulgaria, and Romania where it is estimated that ~100,000 individuals are at risk of BEN, while ~25,000 have the disease. This review summarises current findings on the aetiology of BEN. Over the last 50 years, several hypotheses on the cause of BEN have been formulated, including mycotoxins, heavy metals, viruses, and trace-element insufficiencies. However, recent molecular epidemiological studies provide a strong case that chronic dietary exposure to aristolochic acid (AA) a principal component of Aristolochia clematitis which grows as a weed in the wheat fields of the endemic regions is the cause of BEN and associated UUC. One of the still enigmatic features of BEN that need to be resolved is why the prevalence of BEN is only 3-7 %. This suggests that individual genetic susceptibilities to AA exist in humans. In fact dietary ingestion of AA along with individual genetic susceptibility provides a scenario that plausibly can explain all the peculiarities of BEN such as geographical distribution and high risk of urothelial cancer. For the countries harbouring BEN implementing public health measures to avoid AA exposure is of the utmost importance because this seems to be the best way to eradicate this once mysterious disease to which the residents of BEN villages have been completely and utterly at mercy for so long.

Selection of lactic acid bacteria strains for the hydrolysis of allergenic proteins of wheat flour

BACKGROUND

Wheat flour is one of the most common causative agents of food allergy. The study presents the selection and characterization of lactic acid bacteria (LAB) strains capable of hydrolyzing/modifying allergenic proteins of wheat flour. Hydrolysis of wheat proteins was determined with sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting with sera from patients with food allergy to gluten.

RESULTS

The analysis of electrophoretic profiles of protein extracted from sourdough shows the capability of selected LAB strains for proteolytic degradation of wheat proteins that belong to two factions: albumin/globulin (hydrolysis of 13 polypeptides with a molecular weight between 103 and 22 kDa); and gliadin (seven polypeptides with a molecular weight between 39 and 24 kDa). All analyzed strains were capable of hydrolyzing some IgE-binding epitopes of wheat allergens. The lack of such changes in control samples indicates that they were induced rather by the proteolytic activity of bacterial strains than endogenous enzymes of wheat flour. The gluten proteins were susceptible to hydrolysis by sequential digestion with pepsin and trypsin.

CONCLUSION

The selected strains exhibit proteolytic activity, which leads to a reduction in allergenicity of wheat sourdoughs. These strains may be applied as specific starter cultures to prepare bakery products of special nutritional use. © 2015 Society of Chemical Industry.

[Focus: baker's asthma. Epidemiology, diagnosis and treatment of baker's asthma]

Baker's asthma, though having been recognized and studied since long time, still stays one of the most common causes of occupational asthma. Moreover, our understanding of the causative agents, the pathophysiological mnechanisms, the usefulness of medical surveillance, the proper treatment and prevention of the disease is still scanty. This is due to either to its complex pathogenesis or to possible confoundings, besides the still inadequate quality and standardization of the tools available as far as the allergologic diagnosis is concerned. Proper medical surveillance, validated causal therapies, efficient primary prevention are still uncertain. Change of employment or relocation is often impossible, particularly among artisan workers. Various evidences have been critically revised and summarized.

Nutritional properties of einkorn wheat (Triticum monococcum L.)

The hulled wheat einkorn (Triticum monococcum L. ssp. monococcum), a staple food of early farmers for many thousand years, today is cropped only in small areas of the Mediterranean region and continental Europe. Increasing attention to the nutritional quality of foods has fostered renewed interest in this low-impact crop. The reappraisal of einkorn quality evidenced that this ancient wheat has some dietary advantages over polyploid wheats. Einkorn wholemeal is poor in dietary fibre but rich in proteins, lipids (mostly unsaturated fatty acids), fructans and trace elements (including zinc and iron). The good concentration of several antioxidant compounds (carotenoids, tocols, conjugated polyphenols, alkylresorcinols and phytosterols) and low β-amylase and lipoxygenase activities (which limit antioxidant degradation during food processing) contribute to the excellent nutritional properties of its flour, superior to those of other wheats. Conversely, einkorn has relatively low bound polyphenol content and high polyphenol oxidase activity. In spite of eliciting weaker toxic reactions than other Triticum species, einkorn is not suitable for coeliacs. Current trends towards the consumption of functional foods suggest that this cereal may still play a significant role in human consumption, especially in the development of new or special foods with superior nutritional quality.

Oral mite anaphylaxis caused by mite-contaminated okonomiyaki/ pancake-mix in Japan: 8 case reports and a review of 28 reported cases

BACKGROUND

Anaphylaxis after the ingestion of foods contaminated with mites has recently been recognized. Case series and case reports thus far have shown that mite-contaminated wheat flour is the major cause of oral mite anaphylaxis. However, we have found 8 cases of oral mite anaphylaxis which were caused by mite-contaminated okonomiyaki-mix, a savory Japanese style pancake mix, in our hospital.

METHODS

In addition to our 8 cases, the databases of MEDLINE and ICHUSHI were systematically searched for patients with oral mite anaphylaxis in Japan.

RESULTS

Thirty-six patients including our 8 cases with oral mite anaphylaxis were identified. Thirty-four out of 36 cases (94%) ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki-mix or takoyaki-mix which was previously opened and stored for months at ambient temperature. Microscopic examination of culprit mixes of 16 cases including our 1 case revealed contamination of mites such as Dermatophagoides farina (Der f) (5 cases), Tyrophagus putrescentiae (Tyr p) (4 cases), and Dermatophagoides pteronyssinus (Der p) (3 cases). The specific IgE to each mite is generally upregulated in these patients. Especially, the titers of specific IgE to Der p and Der f were more than class 2 in all cases.

CONCLUSIONS

Mite-contaminated flavored flour is the major cause of oral mite anaphylaxis in Japan.

First case report of anaphylaxis caused by Rajgira seed flour (Amaranthus paniculatus) from India: a clinico-immunologic evaluation

The prevalence of food allergy is reported to be 3-4% in adults and about 6% in children. However food allergy across different countries accounts for 35-50 % all cases of anaphylaxis to foods. In the present study, we have reported a case of anaphylaxis to Amaranth grain (Amaranthus paniculatus) commonly known as Rajgira (Ramdana) in India. A 60 year old female suffered anaphylaxis after consuming Rajgira seed flour generally consumed during fasting. Food allergy to Amaranth seeds is not reported so far. The patient reported to hospital with complaints of itching in mouth, choking throat, redness and swelling of face and burning abdomen within 5 min of consuming Rajgira flour. Clinical and immunological investigations revealed SPT and oral challenge positivity beside high allergen specific IgE in the serum of the patient. Three IgE binding protein fractions were detected in roasted Rajgira seed flour extract which could be considered to be allergenically important for triggering anaphylaxis.

The 'take home' burden of workplace sensitizers: flour contamination in bakers' families

BACKGROUND

Exposure to flour/flour constituents is a leading cause of occupational asthma. Paternal occupational exposure to flour has been associated with increased likelihood of childhood asthma, raising the possibility of para-occupational exposure whereby family members are exposed to sensitizers 'taken home' on contaminated skin/clothing.

OBJECTIVE

To establish whether workplace contamination of skin/clothing with wheat flour allergen (WFA) and fungal α-amylase (FAA) is associated with increased levels of these allergens in bakers' homes.

METHODS

Bakeries in north-east Scotland were invited to participate. Control subjects were recruited from University of Aberdeen staff and students. Exposure assessment was carried out in bakeries, bakers' cars and the homes of bakers and controls using surface wipe and vacuum sampling; samples were analyzed for total protein, FAA and WFA.

RESULTS

164 wipe samples and 49 vacuum samples were collected from 38 bakers (from 5 bakeries) and 10 controls. Compared to non-bakers, bakers had higher median levels of WFA and FAA in house vacuum samples; the difference was statistically significant for WFA/total protein (515.8×10(-6) vs. 163.7×10(-6), p=0.031), FAA/total protein ratios (1.45×10(-6) vs. 0.04×10(-6), p<0.001) and FAA loading (median 1.2 pg/cm(2) vs. 0.1 pg/cm(2), p<0.001) with workplace exposure-home contamination relationships between bakers with higher and lower workplace contamination. We found positive correlations between WFA contamination of the bakers' foreheads and cars (r(s)0.57, p=0.028), foreheads and houses (r(s)0.46, p=0.025), shoes and houses (r(s)0.45, p=0.029); and between FAA contamination of shoes and houses (r(s)0.46, p=0.023), and cars and houses (r(s)0.70, p=0.008). There was no evidence of bakers using work-sourced flour for domestic baking.

CONCLUSIONS

This work demonstrates pathways for 'take home' exposure of occupationally sourced flour. Taken with our previous work, showing that bakers' children are more likely to have asthma, this supports the need for further investigation to establish whether 'take home' of occupationally sourced flour is widespread with health consequences.

Skin symptoms in bakery and auto body shop workers: associations with exposure and respiratory symptoms

Purpose

Despite the importance of skin exposure, studies of skin symptoms in relation to exposure and respiratory symptoms are rare. The goals of this study were to describe exposure–response relationships for skin symptoms, and to investigate associations between skin and respiratory symptoms in bakery and auto body shop workers.

Methods

Data from previous studies of bakery and auto body shop workers were analyzed. Average exposure estimates for wheat allergen and isocyanates were used. Generalized linear models were constructed to describe the relationships between exposure and skin symptoms, as well as between skin and respiratory symptoms.

Results

Data from 723 bakery and 473 auto body shop workers were analyzed. In total, 5.3 % of bakery and 6.1 % of auto body shop workers were female; subjects’ mean age was 39 and 38 years, respectively. Exposure–response relationships were observed in auto body shop workers for itchy or dry skin (PR 1.55, 95 % CI 1.2–2.0) and work-related itchy skin (PR 1.97, 95 % CI 1.2–3.3). A possible exposure–response relationship for work-related itchy skin in bakery workers did not reach statistical significance. In both groups, reporting skin symptoms was strongly and significantly associated with reporting respiratory symptoms, both work-related and non-work-related.

Conclusions

Exposure–response relationships were observed for skin symptoms in auto body shop workers. The lack of significant exposure–response associations in bakery workers should be interpreted cautiously. Workers who reported skin symptoms were up to four times more likely to report respiratory symptoms. Improved awareness of both skin and respiratory outcomes in exposed workers is needed.

Electronic supplementary material

The online version of this article (doi:10.1007/s00420-012-0760-x) contains supplementary material, which is available to authorized users.

Molecular allergology in practice: an unusual case of LTP allergy

The authors describe an unusual case of LTP allergy. A 35 years old patient presented repeated episodes of angiooedema after food intake and complained 10 years ago of contact urticaria and rhinoconjunctivitis when exposed to cannabis leaves and to marijuana smoke. The suspected responsible foods, such as wheat flour in bread, are known to contain LTR Oral syndrome occurred after ingestion of walnuts. Cutaneous tests confirmed immediate responses to several flours and nuts and also to cannabis leaf and flower. A few months later he had similar accidents following peach ingestion and drinking of beer and several wines which all induced positive skin tests. Serological investigations using ImmunoCAP and ISAC microarray confirmed IgE positivity for n Pru p3, r Cor a 8 and n Art v3. It was assumed that sensitization to LTP, the major allergen of cannabis, was responsible of the primary sensitization and induced further LTP food allergies.

Does α-amino-β-methylaminopropionic acid (BMAA) play a role in neurodegeneration?

The association of α-amino-β-methylaminopropionic acid (BMAA) with elevated incidence of amyotrophic lateral sclerosis/Parkinson’s disease complex (ALS/PDC) was first identified on the island of Guam. BMAA has been shown to be produced across the cyanobacterial order and its detection has been reported in a variety of aquatic and terrestrial environments worldwide, suggesting that it is ubiquitous. Various in vivo studies on rats, mice, chicks and monkeys have shown that it can cause neurodegenerative symptoms such as ataxia and convulsions. Zebrafish research has also shown disruption to neural development after BMAA exposure. In vitro studies on mice, rats and leeches have shown that BMAA acts predominantly on motor neurons. Observed increases in the generation of reactive oxygen species (ROS) and Ca²⁺ influx, coupled with disruption to mitochondrial activity and general neuronal death, indicate that the main mode of activity is via excitotoxic mechanisms. The current review pertaining to the neurotoxicity of BMAA clearly demonstrates its ability to adversely affect neural tissues, and implicates it as a potentially significant compound in the aetiology of neurodegenerative disease. When considering the potential adverse health effects upon exposure to this compound, further research to better understand the modes of toxicity of BMAA and the environmental exposure limits is essential.

[Baker's asthma. Experimental studies]

Baker's asthma is one of the most commonly reported occupational lung diseases in countries, and is characterized by rhinitis, bronchial hyperresponsiveness, and reversible airflow obstruction. The development of a mouse model could be useful in order to characterize the development and progression of baker's asthma.

RESULTS

Experimental studies evidenced that flour dust elicits neutrophilic inflammation in a tlr4-independent manner, suggesting that endotoxin is not playing a role in the inflammatory response to flour dust. Moreover, bakery flour dust and dust extract significantly enhance pre-existing allergic asthma in OVA sensitized and challenged mice.

CONCLUSIONS

Bakery flour dust is strongly pro-inflammatory, can cause non-allergic airway inflammation, and can enhance allergen-mediated airway inflammation.

[Asthma and baker's allergy: experience with health programs]

Wheat flour sensitization may lead to several occupational diseases: persistent rhinitis, intermittent or persistent asthma, conjunctivitis, urticaria, and contact dermatitis. The main allergenic components of wheat have been identified, the prevalent mechanism is IgE-mediated, the worsening after starting of sensitization shows the characters of the "allergy march" till the respiratory functional impairment and disability. Nowadays the occupational rhinitis is the first important step to begin to start prevention, but its relevance is also for quality of life of subjects. Data about the prevalence of the sensitization in Italy seem to be spread, ranging from 4% to 24% in the literature and till 32% in a recent our investigation. A complete and early diagnosis is essential to manage the allergic bakers, aiming relocation in their own activity. A specific immunotherapy by allergenic vaccine has been studied and it is now possible. In our experience 43 bakers and pastry makers were treated by the same vaccine (Lofarma Laboratories, Milan) and revalued after many years; 83% were still at work and 70% claimed only poor or no-symptoms during work, in any way with a tolerable condition. At present the baker's disease may be managed by included interventions "man-environment" avoiding the extreme choice of leaving the working activity. The Lombardy Government published specific Guide Lines on the prevention and proposed a planned project for three years, to be adopted according to local needs in collaboration with the public health service.

[The Bergamo experience of health surveillance in the bakery sector]

The purpose of this study is to analyse the various risk factors present in the artisan and semi industrial bread making technological cycle as well as verify the kind of illnesses and ailments encountered amongst the workforce. The objective being to identify a preventive action programme together with the necessary Health support measures. Our case study, drew upon a sample of 428 workers (252 bread makers and 176 sales staff). Each of them was asked to complete a questionnaire about the production process, the kind of exposure to wheat flour particles, smoking habits, present or past common allergy pathologies, the symptoms connected to the work, both in the allergic and osteomuscular field. Those positive respondents were subjected to various medical tests so as to ascertain a definitive diagnosis of their ailments. As was easy to predict, the most common pathology (ailment), found amongst bread makers, related to the respiratory system--16.7% of the population. In particular, 7.5% was affected by eye rhinitis, 2.8% by allergic bronchial asthma, 3.2% indicated a mix between rhinitis and bronchial asthma and 3.2% by BPCO. Skin ailments affected 2% of workers and WMSDs more than 2.8%.

Exposure to flour dust and sensitization among bakery employees

BACKGROUND

The National Institute for Occupational Safety and Health conducted a study to determine prevalences of sensitization to bakery-associated antigens (BAAs) and work-related respiratory symptoms at a large commercial bakery.

METHODS

The following measurements were carried out: personal breathing zone (PBZ) and general area (GA) monitoring for inhalable flour dust, α-amylase and wheat, a questionnaire, and blood tests for IgE specific to flour dust, wheat, α-amylase, and common aeroallergens.

RESULTS

Of 186 bakery employees present during our site visit, 161 completed the questionnaire and 96 allowed their blood to be drawn. The geometric mean PBZ and GA inhalable flour dust concentrations for the lower-exposure group was 0.235 mg/m(3), and for the higher-exposure group was 3.01 mg/m(3). Employees in the higher-exposure group had significantly higher prevalences of work-related wheezing, runny nose, stuffy nose, and frequent sneezing than the lower-exposure group. The prevalence of IgE specific to wheat was significantly higher among employees who ever had a job in the higher-exposure group or in production at another bakery at both the ≥ 0.10 kU/L and the ≥ 0.35 kU/L cutoffs, and to flour dust and α-amylase at the ≥ 0.10 kU/L cutoff, compared to the lower-exposure group.

CONCLUSIONS

Despite knowledge of the risks of exposure to flour being available for centuries, U.S. employees are still at risk of sensitization and respiratory symptoms from exposure to high levels of BAA.

Recurrent anaphylaxis due to lupin flour: primary sensitization through inhalation

Allergic reactions to lupin have increased in parallel with the growing use of lupin flour by food manufacturers. We studied a patient with recurrent anaphylaxis to manufactured foods and a history of rhinitis-asthma related to lupin inhalation and legume tolerance. Skin prick tests with airborne and food allergens, specific immunoglobulin (Ig) E determinations, and an inhalation exposure test to ground lupin were carried out. Lupin allergens and cross-reactivity with other legumes were also studied using sodium dodecyl sulfate polyacrylamide gel electrophoresis and immunoblotting/immunoblotting inhibition. The skin tests and specific IgE were positive for lupin and vetchling and negative for other legumes. The presence of lupin flour in the implicated foods was confirmed. Immunoblotting showed multiple IgE-binding bands (10-40 kDa) for lupin and vetchling but not for peanut, pea, or soy extracts. Immunoblotting inhibition demonstrated intense lupin-vetchling cross-reactivity. We present a case of recurrent anaphylaxis due to lupin flour as a hidden food allergen with primary sensitization due to exposure to ground lupin via inhalation. We found cross-reactivity between lupin and vetchling but not other legumes.

Sequential sensitization to different occupational compounds in a young woman

BACKGROUND

Very few authors have reported sensitization to two or more different occupational sensitizers in a single patient.

OBJECTIVE

To describe a subject with occupational asthma caused by sensitization to two different agents, exposure to which occurred in dierent time periods.

METHODS

We studied a young woman with asthma-like symptoms predominantly in relationship to a sequential occupational exposure, first to methylene diisocyanate (MDI) and later to flour dust. In the first and second periods of occupational exposure, the patient was subjected to metbacholine challenge test (MCT), sputum analysis, and specific challenge test (SCT).

RESULTS

At the first observation, MCT (PD20FEV1: 0.109 mg) and SCT with MDI were positive and induced sputum analysis showed a high percentage of eosinophils (32%). The patient reduced exposure to MDI but symptoms worsened with continuing occupational exposure. After one year, she started another job exposed to flour dust. After four years, asthma symptoms persisted despite treatment with inhaled corticosteroids and bronchodilators, and bronchial byperreactivity and sputum eosinophbilia were still present (PD2OFEV1: 0.067 mg; sputum eosinophils: 5.3%). The patient also developed rhinitis symptoms associated with dermatitis. A SCT with flour dust showed an immediate response (deltaFEV1: 33%). The subject left work and a year later was still symptomatic:pulmonary function was within normal limits under regular therapy and induced sputum showed absence of eosinophilia.

CONCLUSIONS

This was an unusual case of double sensitization to different occupational compounds to which the patient was exposed in different time periodsj suggesting the role of a pre-existing occupational aSthma in the development and/or worsening of sensitization to other occupational agents.

Dust mite infestation of flour samples

BACKGROUND

Ingestion of flour contaminated with dust mite may trigger severe anaphylaxis in tropical and sub-tropical regions.

AIMS

This study aimed to evaluate environmental factors that affect dust mite propagation in the tropics.

MATERIALS & METHODS

Dust mites were introduced to a variety of flour samples and incubated at two different environmental conditions.

RESULTS

It was found that dust mites populations flourished best in wheat flour compared to other varieties of flour, and at ambient temperatures with high humidity instead of the air conditioned environment.

CONCLUSION

Dust mite infestation of flour is dependent on the presence of wheat and high ambient temperature in the tropics.

Determinants of specific sensitization in flour allergens in workers in bakeries with use of skin prick tests

Baker's asthma, like other forms of occupational asthma is probably the most serious manifestation of occupational allergy among bakery workers. It is caused by immunologic sensitization and subsequent allergic reactions in the airways to occupational specific airborne allergens. Skin Prick Tests (SPTs) play an important role in the diagnosis of baker's asthma and epidemiological field studies on frequencies of sensitization to flour. This paper presents a review of the available literature on prevalence of flours sensitization in bakery workers. Atopy and level of exposure appears to be a very strong determinant for sensitization to flour allergens. Prevention strategies and standard setting are discussed.

The neurotoxic effect of palmyrah (Borassus flabellifer) flour re-visited

The neurotoxic effect of palmyrah (Borassus flabellifer L.) shoot flour on Wistar rats has been reported previously by Arseculeratne and co-workers. A deficiency in previous studies was an inadequate description of the methodology, especially on the composition and consumption of test and control feed, and weight gain/losses. This study shows that feeds containing 100% and 70% palmyrah flour result in very little or no feed consumption, and deaths reported could have been interpreted as being due to starvation. A mixture of 50% palmyrah flour and 50% standard breeding feed results in the neurotoxic symptoms such as muscle in-coordination, spasms and immobility of hind limbs reported previously (Arseculeratne and coworkers). These neurotoxic symptoms can be eliminated by heating the palmyrah flour at 80 degrees C for 45 min; that is, detoxification. Attempts were made to reproduce the neurotoxic effect by administering two-fold palmyrah flour extractive compared with that contained in the same flour consumed by experimental rats per day. This did not produce a neurotoxic effects (as reported previously while using rats fed on standard breeding feed). It is interpreted that the nutritional status of the diet influences that manifestation of the neurotoxic effect; the effect being suppressed with a nutritious diet. Studies on the blood enzyme levels of rats showed that while alanine aminotransferase was not affected, aspartate aminotransferase was significantly affected by oral administration of organic solvent-free water and methanol:water (1:1) extractives (P = 0.023 and P = 0.0044), respectively. This study shows that while the reported hepatotoxin is not extracted by these solvent systems, there appears to be a tissue non-specific cellular damage reflected at a subclinical level.

Sensitization to wheat flour and enzymes and associated respiratory symptoms in British bakers

RATIONALE

Current literature suggests that flour exposed workers continue to be at risk of allergic sensitization to flour dust and respiratory ill health.

OBJECTIVES

A cross-sectional study of 225 workers currently potentially exposed to flour dust in British bakeries was performed to identify predictors of sensitization to wheat flour and enzymes.

RESULTS

Work-related nasal irritation was the most commonly reported symptom (28.9%) followed by eye irritation (13.3%) and work-related cough or chest tightness (both 10.2%). Work-related chest tightness was significantly associated (OR 7.9, 1.3-46.0) with co-sensitization to wheat flour and any added enzyme. Working at a bakery with inadequate control measures was not a risk factor for reporting work-related respiratory symptoms (OR 1.3, 0.4-3.7). Fifty-one workers were atopic and 23 (14%) were sensitized to workplace allergens. Atopy was the strongest predictive factor (OR 18.4, 5.3-64.3) determining sensitization. Current versus never smoking (OR 4.7, 1.1-20.8) was a significant risk factor for sensitization to wheat flour or enzymes in atopic workers only, corrected for current level and duration of exposure. This effect was not seen in non-atopic workers (OR 1.9, 0.2-17.9). Evidence of sensitization to less commonly encountered allergens was also seen to Aspergillus niger derived cellulase, hemicellulase and xylanase mix, in addition to glucose oxidase and amyloglucosidase mix.

CONCLUSIONS

The combination of health surveillance and exposure control in this population has been insufficient to prevent clinically significant workplace sensitization. Smoking may pose an additional risk factor for sensitization in atopic workers. Am. J. Ind. Med. 52:133-140, 2009.

Prediction of challenge test results by flour-specific IgE and skin prick test in symptomatic bakers

BACKGROUND

Wheat and rye flours are among the most important allergens causing occupational asthma. Usually, the diagnosis of baker's asthma is based on inhalation challenge tests with flours.

AIMS OF THE STUDY

To evaluate the relevance of flour-specific serum immunoglobulin E (IgE) and skin prick test (SPT) in the diagnosis of baker's asthma and to define flour-specific IgE concentrations and wheal sizes that allow a prediction of the outcome of challenge testing.

METHODS

Bronchial and nasal challenge tests with wheat (rye) flour were performed in 71 (95) symptomatic bakers. Determinations of flour-specific IgE as well as SPTs were performed in all subjects. Analyses included the calculation of sensitivity, specificity, positive (PPV) and negative predictive values (NPV) at different IgE concentrations and different wheal sizes, and receiver-operating characteristics (ROC) plots with the challenge result as gold standard.

RESULTS

Thirty-seven bakers were positive in the challenge with wheat flour, while 63 were positive with rye flour. Depending on the flour-specific IgE concentrations (wheal size), PPV was 74-100% (74-100%) for wheat and 82-100% (91-100%) for rye flour, respectively. The minimal cut-off values with a PPV of 100% were 2.32 kU/l (5.0 mm) for wheat flour and 9.64 kU/l (4.5 mm) for rye flour. The shapes of the ROC plots were similar for wheat and rye flour.

CONCLUSION

High concentrations of flour-specific IgE and clear SPT results in symptomatic bakers are good predictors for a positive challenge test. Challenge tests with flours may be avoided in strongly sensitized bakers.

[Epidemiology and etiologic agents of occupational asthma]

INTRODUCTION

Occupational asthma is, by definition, a disease that can be prevented through appropriate protective strategies. Epidemiological information is required to guide these interventions, and we here examine epidemiological data on the burden, causes, and risk factors for this condition.

STATE OF THE ART

Population-based surveys indicate that approximately 15% of adult asthma is attributable to the workplace environment. The most common occupational agents implicated include flour, isocyanates, latex, and persulphate salts. The occupations in which occupational asthma has been most commonly reported are bakers, spray painters, health-care workers, hairdressers, and cleaners. The level of exposure to sensitizing agents seems to be the most relevant risk factor. Atopy is a significant risk factor only for the development of sensitization to high molecular weight agents. The role of other individual determinants, such as genetic factors, has been less consistently established. Occupational asthma is associated with a substantial adverse impact on the employment and financial status of affected workers.

PERSPECTIVES

Methodological improvements are required in order to distinguish more accurately between occupational and work-exacerbated asthma. Further investigations of the effectiveness of primary and secondary preventive interventions are also needed.

Bronchial responsiveness in bakery workers: relation to airway symptoms, IgE sensitization, nasal indices of inflammation, flour dust exposure and smoking

BACKGROUND

Bronchial hyperresponsiveness (BHR) is common in bakery workers. The relation between bronchial responsiveness measured with a tidal breathing method and smoking, airway symptoms, IgE-sensitization, nasal indices of inflammation and flour dust exposure have been studied with bronchial responsiveness expressed as a continuous outcome.

MATERIAL AND METHODS

Bakery workers (n = 197) were subjected to interviews, questionnaires, allergy tests, workplace dust measurements and bronchial metacholine provocation. Eosinophil cationic protein (ECP) and alpha(2)-macroglobulin were measured in nasal lavage. Bronchial responsiveness was expressed as slope(conc), a measurement based on regressing the per cent reduction in FEV(1) at each provocation step.

RESULTS

BHR expressed as slope(conc) was associated with smoking (P = 0.009), asthma symptoms at work (P = 0.001), and occupational IgE sensitization (P = 0.048). After adjusting for baseline lung function the association between BHR and IgE sensitization was no longer present. We demonstrated an association between nasal ECP and BHR (slope(conc) < 3: P = 0.012), but not to alpha(2)-macroglobulin in nasal lavage. No association was seen between BHR and current exposure level of flour dust, number of working years in a bakery or a history of dough-making.

CONCLUSION

BHR is related to baseline lung function, work-related asthma symptoms, smoking and nasal eosinophil activity, but not to occupational IgE sensitization and current flour dust exposure when measured with metacholine provocation. The slope(conc) expression seems to be a useful continuous outcome in bronchial responsiveness testing.

Anaphylactic reaction to lupine flour

Roasted lupine seeds have been used as snack food in Mediterranean countries for years. Since the 1990s, lupine flour has been used as a substitute for or additive to other flours in countries of the European Union; usually the amount is so low that no declaration is required. Since 1994, a number of cases of immediate-type allergy to lupine flour-containing products have been published. A 52-year-old woman developed facial and mucosal edema, followed by dizziness and shortness of breath a few minutes after ingestion of a nut croissant containing lupine flour; she required emergency care. Allergy diagnostic tests revealed a total IgE of 116 kU/l, a highly elevated concentration of IgE specific for lupine seed (42.9 kU/l) and birch pollen IgE of 2.57 kU/l. Skin prick test with native lupine flour was strongly positive. Allergy against lupine seeds may develop de novo or via cross-reactivity to legumes, particularly peanuts, the latter being detectable in up to 88% of cases, founded on a strong sequence similarity between lupine and peanut allergens. In our patient, no cross-reactivity could be detected via immunoblotting, indicating a rare monovalent sensitization to lupine flour. Treatment consists of avoidance of lupine flour-containing products. Patients with proven peanut allergy should also avoid lupine flour because of the major risk of cross-reaction.

[Specific immunotherapy and relocation in occupational allergic bakers]

Occupational allergy to components of wheat flour is the main cause of rhinitis and asthma of workers in bakeries and similar activities. An immunological mechanism IgE-mediated is involved and the sensitising properties of some proteins of wheat where assessed. Nowadays it is possible to have an extract to be used for specific immunotherapy. The aim of this treatment should be a reduction of individual immunological reactivity and the possibility of going on the particular activity of allergic bakers, pastry makers or pizza makers. An observational crossectional retrospective study was performed on 41 sensitised workers that were diagnosed in the same occupational health unit. All underwent a subcutaneous specific immunotherapy (SCIT) with the same schedule and the same extract (Lofarma Allergeni, Milan) for 4 or more years, without avoiding their work activity. The outcome was investigated after five or ten years. Data were collected by a questionnaire. 34 subjects on 41 are still at work with an acceptable quality of life and a normal working efficiency, mainly in their small enterprises. In the "old" subgroup (19 cases), treated in the past, several bakers still at work stopped SCIT even from 4-10 years. In the "new" subgroup (15 cases), still in treatment, symptoms and drug use during the work activity resulted to be reduced or absent in the majority of cases. According to results of other immunotherapies by allergenic vaccines (pollens, mites) also for wheat flour occupational allergy a specific treatment seems to be possible and SCIT may be an useful tool to reduce and control the biological individual effects of allergy. By the occupational point of view wheat flour SCIT allows a relocation in many of cases and may be associated to other intervention of environmental prevention at workplaces, improving the relocation of occupational allergic subjects when requested.

Approaches to the diagnosis and management of occupational asthma amongst UK respiratory physicians

This study aimed to assess the approach to the diagnosis and management of occupational asthma amongst general (non-specialist) respiratory consultants in the UK. A random sample of 100 UK general respiratory physicians were invited to participate, and asked to provide information on their diagnostic approach to a case scenario of a patient with possible occupational asthma relating to flour exposure. Participation rates were 42% for the main part of the study. Less than half of consultants specifically reported they would ask whether symptoms improved away from work, and just over a third mentioned examining the patient. All of those interviewed recommended a chest X-ray, and 98% simple spirometry. Eighty-six per cent suggested measurement of serial peak flows, recorded for between 2 and 8 weeks, with measurements taken half-twelve hourly. Less than half advocated a specific flour allergy test, and almost one-quarter (23%) would not perform any immunological test at all. Once a diagnosis of occupational asthma was confirmed, less than two-thirds of those interviewed commented they would recommend some form of exposure reduction, and only 28% specifically stated they would offer compensation advice. The diagnosis of occupational asthma by general respiratory physicians within the UK lacks standardisation, and in some cases falls short of evidence-based best practise.

Challenge testing in the diagnosis of occupational allergic conjunctivitis

BACKGROUND

Providing evidence for the allergic aetiology of ocular symptoms developing as a result of occupational exposure is important for compensation procedures in many countries.

AIM

To perform cellular analysis of tear fluid before and after a specific challenge test with high-molecular weight allergens in symptomatic subjects.

METHODS

The subjects were 23 bakers with a history of conjunctivitis or rhinoconjunctivitis associated with occupational exposure to wheat flour and positive skin prick test with this allergen. A specific inhalation challenge test with wheat flour and a placebo test were performed. The symptom score (SS) and cellular changes in tear fluid and nasal washings were assessed.

RESULTS

Specific provocation test induced significant eosinophil influx in tear fluid in only six patients. No changes in the proportion of other cells could be observed. Cytological changes in tear fluid did not correlate with either ocular SS (Pearson r = 0.18, P = 0.40) or changes in the nasal lavage fluid or SS (Pearson r = 0.13, P = 0.56). However, an analysis of SS results obtained at 30 min and at 24 h after the challenge revealed that cellular changes in tear fluid correlated significantly both with the early and late changes in SS (Pearson r = 0.52, P < 0.05 and Pearson r = 0.81, P < 0.001, respectively).

CONCLUSIONS

Analysis of cellular changes in tear fluid during specific inhalation challenge test seems to be a valuable diagnostic tool in occupational ocular allergy. However, the discrepancy between the findings of cellular analysis and SS revealed by the present study requires further research.

Baker's asthma

PURPOSE OF REVIEW

Baker's asthma is one of the leading causes of occupational asthma and this review describes recent developments in the field.

RECENT FINDINGS

The location of bakery production has undergone change and, subsequently, so has the location of baker's asthma. Innovations in the baking industry have also led to new, potentially allergenic, ingredients. A new family of cereal allergens has been identified, including wheat thioredoxin hb (Tri a25). New enzymes are being added to bread that may have allergic potential. The relationship of specific sensitization and baker's asthma has been confirmed in further studies. Measuring specific sensitization to bakery allergens is an essential part of making the diagnosis but there is a lack of standardization of allergen tests. Advancements are being made in the measurement of airborne allergens through the Measurement of Occupational Allergen Exposure project and the development of novel measurement techniques. This will enable better exposure-response relationships and more accurate risk assessment.

SUMMARY

Progress is being made to better identify bakery allergens and measure exposures accurately. Changes in the location of bread production and new allergens mean that the distribution and determinants of baker's asthma are changing.

Specific sensitization in wheat flour and contributing factors in traditional bakers

Skin prick tests (SPTs) play an important role in the diagnosis of bakers asthma and epidemiological field studies on frequencies of sensitization to wheat or rye flour. In many epidemiological studies the investigators have tried to reveal the determinants of specific sensitization, and atopy appears to be a very strong determinant for sensitization to flour allergens. Age and gender have not reported to be determinants of sensitization. Only one study found that sensitization in wheat flour with skin prick test was significantly associated with cigarette smoking. Few data are available on sensitization to wheat flour in populations without occupational exposure to bakery allergens. The aim of this study was to investigate the sensitization of wheat flour and other baking allergens (oat, barley, and rye flour) in traditional bakers and in cleaners in a big hospital in the same area. In addition the correlation of atopy with specific sensitization and the correlation of specific sensitization with age, sex, working hours, working years, smoking status and pack/years with use of skin prick tests.

Effect of cosensitization with buckwheat flour extract on the production of house dust mite-specific IgE

There are studies reporting food sensitization in infancy increases the risk of sensitization to inhalants later in life. We performed a study to evaluate whether cosensitization with buckwheat (BW) has an effect on the production of house dust mite-IgE. C3H/HeJ mice (4 weeks, female) were sensitized with house dust mite (HDM)/Al (OH)(3), intraperitoneally on day 0, followed by 4 intranasal sensitizations (on days 14, 15, 16, and 21). Group 1 was cosensitized intragastrically with BW/cholera toxin (CT) (on days 0, 1, 2, 7, and 18) during sensitization with HDM, group 2 was cosensitized intragastrically with CT only (on days 0, 1, 2, 7, and 18), and group 3 was used as controls. HDM- and BW-IgE and antigen-specific T-cell proliferation and cytokine production were evaluated. In Group 1, BW-IgE levels were highest at week 4, and the HDM-IgE at week 3 (98.45+/-64.37 ng/mL and 169.86+/-55.54 ng/mL, respectively). In Group 2, HDM-IgE levels reached a peak at week 3, remarkably higher (810.52+/-233.29 ng/mL) compared to those of Group 1 (169.86+/-55.54 ng/mL). The interleukin (IL)-4 and interferon (IFN)-beta in the HDM-stimulated culture supernatants of splenocytes were not significantly different among groups. We postulate that the cosensitization with BW may down-regulate the specific IgE response to HDM.

Modelling Exposure in Flour Processing Sectors in The Netherlands: a Baseline Measurement in the Context of an Intervention Program

INTRODUCTION

Recent studies have shown that even low exposure levels to flour dust and related allergens can cause severe respiratory symptoms. In The Netherlands the Dutch government and responsible branch organizations [from bakeries (traditional & industrial), flour mills and bakery ingredient producers] signed a covenant to reduce exposure to flour dust and decrease the prevalence of work-related occupational airway disease. This paper describes a sector wide survey to measure exposure to flour dust, wheat allergens and fungal alpha-amylase. The results are being used to underpin various elements of the covenant.

METHODS

A dataset containing 910 personal measurements was compiled from four field studies containing information on exposure and potential determinants. The dataset represents a baseline estimate of exposure for four major flour processing sectors in The Netherlands. Exposure models for all sectors and agents were generated, based on job, tasks and company size, taking into account worker and company as random effect components. Use of control measures and, where possible, their effect were evaluated.

RESULTS

Flour dust and enzyme exposures vary strongly between sectors. The job performed and specific tasks were identified as important determinants of exposure. The number of identified control measures during walk-through surveys, and their effectiveness in reduction of dust exposure was generally limited. The exposure models explained significant exposure variability between companies and workers but performed poorly in explaining day to day differences in exposure.

DISCUSSION

The dataset serves as a baseline estimate and will be compared with a post intervention survey in the near future. The information obtained on control measures can be used to optimize the intervention scenarios that will be implemented in the different sectors by external occupational hygienists. The predictive exposure models will provide a relevant measure of average personal exposure that will be used in the sector wide health surveillance system.

The influence of workplace environment on lung function of flour mill workers in Jalgaon urban center

The workplace environment affects the health of workers. Unhygienic conditions are observed in the workplace environment of flour mills as fine organic flour dust gets airborne in the indoor environment of the flour mills. The present work was undertaken to study the health problems related to the workplace environment of flour mill workers. The results show that flour mill workers are receiving a heavy dose (average exposure concentration, 624 microg/m3) of flour dust. To determine the impact of flour dust on the lung function of the workers spirometric analysis was conducted. Significant declines in forced vital capacity (FVC), peak expiratory flow rate (PEFR) and forced expiratory volume in one second (FEV1) were observed in the flour mill workers as compared to expected values. This study reveals reduced lung efficiency of flour mill workers due to excessive exposure to fine organic dust prevalent in the workplace environment. The impairment in lung efficiency was increased with duration of exposure in the flour mill workers. The analysis of questionnaires used to generate information on self-reported problems reveals that most of the workers were suffering from asthma and respiratory problems. Furthermore, the data shows that 42% of the flour mill workers were having shortness of breath problems, 34% of workers were having frequent coughing, and 19% workers were having respiratory tract irritation. We recommend the compulsory use of personal protective equipment (nose mask) by flour mill workers during working hours. This would help to protect the workers health from the flour dust prevalent in the workplace environment. A regular periodic examination is necessary to measure the impact of particulate matter on the health of the flour mill workers.

[Two cases of food-dependent exercise-induced anaphylaxis difficult to evoke symptoms by provocation test]

We report two cases of food-dependent exercise-induced anaphylaxis (FDEIA), which were hardly induced by provocation test in the hospital. Case 1: A 28-years-old Japanese female suffers repeated episodes of sternutation, nasal discharge and edema of eyelids after wheat ingestion of wheat followed by exercise. Case 2: A 14-years-old Japanese male suffers repeated episodes of wheal formation on whole body and dyspnea after lunch containing apple followed by exercise. Both of them had never developed symptoms by either ingestion or exercise alone. Provocation tests were performed on admission by combinations of the ingestion of suspected foods, exercise, and aspirin, but no symptoms were reproduced by any combination of them. After discharge, case 1 reproduced symptoms during exercise after the ingestion of wheat under prostration and cold climate. Case 2 reproduced symptoms during exercise after ingestion of apple when he suffered from common cold. Warm and comfortable condition in admission may make it harder to evoke symptoms by the provocation test. Frigidity, cold, prostration, and stress should be reckoned with in the provocation test to improve the accuracy of diagnosis for FDEIA.

Maize (Zea mays): allergen or toleragen? Participation of the cereal in allergic disease and positivity incidence in cutaneous tests

BACKGROUND

The maize (zea mays) is considered one of the fundamental nutrients in the diet of the Mexican population. It can cause allergic reactions, according to reports from countries other than Mexico.

OBJECTIVE

To know the participation of maize in the etiology of allergic disease and the incidence of positivity to its antigens by cutaneous tests, in Mexican patients.

METHODS

Six hundred sixty-one patients were studied. There were obtained a complete clinical history and samples for laboratory tests, as well as the results of cutaneous tests.

RESULTS

Of 661 patients, 56 (8.5%) manifested allergic symptoms attributable to maize, which correlated (p < 0.0001) with a positive cutaneous response to its antigens. Fifty (88%) of them worked with maize and had a significant relative risk value (RR=102). The remaining six patients did not work with maize, four of them were included in the group who had a positive response for both allergens (n = 25), and two in that one with positive response for only one of these allergens (n = 100).

CONCLUSIONS

The low frequency (8.5%) to which the allergic disease was attributed to maize, and the strong association (88%) with workers of maize induce us to consider the influence of some differences concerning to the cereal, such as physical characteristics, years and frequency to contact with, and specially to its entrance route. In fact, it plays an important role in the development of either toleragenic or immunogenic response to an antigen.

Response of Respiratory Flour Allergics in an Ingested Flour Challenge May Involve Plasmacytoid Dendritic Cells, CD25+ and CD152+ T Cells

BACKGROUND

A number of occupational respiratory allergens are food related, and little is known about the responses these allergens elicit in sensitized persons that ingest them.

METHODS

Nine respiratory flour-allergic volunteers were exposed in a double-blind placebo-controlled food challenge with flour. Responses were monitored by spirometry, acoustic rhinometry, determination of urinary methyl histamine and tryptase and flow cytometric evaluation of basophil, dendritic and T cell numbers and markers.

RESULTS

Significant increases in serum tryptase (compared with placebo post-exposure levels) and methyl histamine and a coordinated decrease in blood basophils and nasal volume after ingestion of allergen compared with placebo suggest an allergic response to ingested allergen. There was no change in forced expiratory volume in 1 s. The number of blood plasmacytoid dendritic cells (DC), but not of myeloid DC, decreased after exposure (p = 0.001). DC HLA DR was reduced after both exposures (p < 0.001). Expression of CXCR4 on DC was reduced after allergen (p = 0.033) but not after placebo exposure. CD4+ T cell expression of CD25 was elevated after placebo (p = 0.021) but reduced after allergen provocation. The reduction in CD25 expression after allergen compared with placebo was significant (p = 0.024). CD152 was downregulated on these cells after allergen (p = 0.039) but less so after placebo exposure.

CONCLUSION

Persons with respiratory allergy respond after ingestion of the relevant allergen. Response to this allergen challenge may selectively recruit plasmacytoid DC through CXCR4 and T cells expressing CD25 and CD152, which may be a regulatory phenotype.

Occupational rhinoconjunctivitis and asthma by exposure to Lathyrus sativus flour

We report the case of a 42-year-old non-smoking man, who had worked as a carpenter for 6 years and who reported a history of rhinorrhea, paroxysmal sneezing, nasocular pruritus, lacrimation, wheezing and dyspnea attacks while preparing a mixture to seal the junctures between wooden panels. Allergy study consisted of skin prick testing (SPT) to inhalants, foods and Lathyrus sativus flour (LSF) extract, specific bronchial provocation test with LSF extract, cytological analysis of sputum, specific IgE antibodies against LSF, and histamine releasing test with dilutions (1:5, 1:25, 1:125, 1:625) of LSF. The results demonstrated occupational rhinoconjunctivitis and asthma due to LSF exposure. We provide a review of published reports to date.