Occupational Asthma in Female Factory Worker Resulting from Exposure to Savinase in Dishwashing Tablets–A Case Study

Journal of Occupational Health
Article ID: 12-0169-CS

Language:      English     Japanese   

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http://dx.doi.org/10.1539/joh.12-0169-CS

 

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Occupational Asthma in Female Factory Worker Resulting from Exposure to Savinase in Dishwashing Tablets–A Case Study

Agnieszka Lipińska-Ojrzanowska¹⁾, Dominika Świerczyńska-Machura²⁾, Diana Tymoszuk¹⁾, Ewa Nowakowska-Świrta²⁾, Jolanta Walusiak-Skorupa¹⁾

1) Department of Occupational Diseases, Nofer Institute of Occupational Medicine 2) Centre of Occupational Allergy and Environmental Health, Nofer Institute of Occupational Medicine

 [Advance Publication] Released: 2013/05/02

Keywords: Detergents, Dishwashing tablet, Occupational asthma (OA), Savinase, Sensitization to enzymes, Subtilisin

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Objectives: Savinase is one of the endopeptidases widely used in washing detergents. Its ability to cause respiratory allergy has been known. Up to now, most cases of occupational asthma (OA) to savinase have been described among workers involved in the manufacture of laundry detergents. We present a case study of 51-year-old female worker of a dishwashing tablets factory, who had been packaging ready-made tablets into foil wrappers for 4 years and developed respiratory symptoms, such as cough, dyspnoea and wheezing.Methods: A number of clinical procedures were performed, including the clinical examination, routine laboratory tests, evaluation of total and allergen-specific serum IgE (asIgE) to enzymes, skin prick tests for common allergens, rest spirometry, inhalation methacholine challenge test and a single-blind, placebo-controlled specific inhalation challenge test (SICT) with dishwashing tablets. Results: Clinical findings and results of routine laboratory tests were within normal limits. Baseline nonspecific bronchial hyperreactivity was revealed. In patient’s serum blood we found significantly elevated asIgE to savinase. Decline of FEV₁ and PEF in late phase of asthmatic reaction was observed during the specific challenge test. The patient reported chest tightness between 5-12 hours after exposure to dishwashing tablet ingredients. Cytological assessment of an induced sputum revealed increase in the percentage of eosinophils 24h after specific challenge in comparison to values noted before the SICT. Conclusion: Positive clinical response to the challenge confirmed in objective method tests validated the diagnosis of OA.

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Immunomodulatory and Anti-Allergic Effects of Orally Administered Lactobacillus Species in Ovalbumin-Sensitized Mice

Journal of Microbiology and Biotechnology

 2013 ; 23(5): 724~730

Author	Jeongmin Lee, Jieun Bang, Hee-Jong Woo
Affiliation	Laboratory of Immunology, College of Veterinary Medicine, Seoul National University, Seoul 151-742, Korea,Division of Zoonoses, Center for Immunology and Pathology, National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongwon-gun, Chungcheongbuk-do 363-951, Korea
Title	Immunomodulatory and Anti-Allergic Effects of Orally Administered Lactobacillus Species in Ovalbumin-Sensitized Mice
PublicationInfo	J. Microbiol. Biotechnol.2013 ; 23(5): 724~730
Abstract	We investigated the effects of orally administered probiotic bacteria (Lactobacillus species) as allergic immune modulators in ovalbumin (OVA)-sensitized mice. BALB/c mice were intraperitoneally injected with OVA twice at a 2-week interval for allergy sensitization. The mice were then orally administered Lactobacillus casei YIT9029 (L1), L. casei HY7201 (L2), L. brevis HY7401 (L3), or L. plantarum HY20301 (L4) every 2 days for 3 weeks. Total IgE levels significantly decreased in sera of L3-administered mice but increased in the other groups. OVA-specific IgE levels decreased slightly in sera of mice administered L1, L3, and L4 but increased significantly in L2-administered mice. In passive cutaneous anaphylaxis (PCA) using sera from administered mice, only the L3-administered group showed reaction inhibition. High expression of TLR-2 with interferon (IFN)-γ stimulation on peripheral blood mononuclear cells occurred in L3- or L4-administered mice. Th1 cytokines, including IFN-γ and interleukin (IL)- 12, increased in splenocytes of L3-administered mice; however, IL-4 decreased in L1- and L4-administered groups; IL-5 decreased in all experimental groups. IL-6 decreased in the L3-administered group; and IL-10 decreased in L1-, L2-, and L3-administered groups. L3 induced antiallergic effects by increasing Th1 cytokines, decreasing Th2 cytokines, and inhibiting the PCA reaction, whereas L2 administration increased allergic effects.
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Keywords	allergy, oral administration, probiotics, Lactobacillus

Aspirin desensitisation for Chinese patients with coronary artery disease

Aspirin desensitisation for Chinese patients with coronary artery disease
Joe KT Lee, KL Tsui, CY Cheung, CH Chau, HL Chan, KL Wu, Gary SH Cheung, MC Choi, KK Chan, SK Li
Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
Objective. To assess the efficacy and safety of aspirin desensitisation in Chinese patients with coronary artery disease.
Design. Case series.
Setting. A regional hospital in Hong Kong.
Patients. Chinese patients with coronary artery disease and a history of a hypersensitivity reaction to aspirin or non-steroidal anti-inflammatory drug, who underwent aspirin desensitisation between February 2008 and July 2012.
Results. There were 24 Chinese patients with coronary artery disease who were admitted to our unit for aspirin desensitisation during this period. The majority (79%) were clinical admissions for desensitisation; eight (33%) of them developed a hypersensitivity reaction during desensitisation. Half of the latter had only limited cutaneous reactions and were able to complete the desensitisation protocol and developed aspirin tolerance. Overall, 20 (83%) of the patients were successfully desensitised at the initial attempt. No serious adverse reactions occurred in the cohort. Twelve of the patients had significant coronary artery disease revealed by coronary angiography and received a percutaneous coronary intervention, nine of whom received drug-eluting stents while three received bare metal stents due to financial constraints. All 11 successfully desensitised patients received aspirin and clopidogrel as double antiplatelet therapy after percutaneous coronary intervention. The remaining patient had a bare metal stent implant due to failed aspirin desensitisation.
Conclusion. Given the potentially different genetic basis of aspirin hypersensitivity in different ethnicities, recourse to desensitisation in the Chinese population has not previously been addressed. This study demonstrated that aspirin desensitisation using a rapid protocol can be performed effectively and safely in Chinese patients. Our results were comparable to those in other reported studies involving other ethnicities. Successful aspirin desensitisation permits patients to pursue long-term double antiplatelet therapy that includes aspirin after percutaneous coronary intervention, and thus allows the use of drug-eluting stents as a feasible option.

Hong Kong Med J 2013;19:Epub 2013 May 6  |  DOI: 10.12809/hkmj133914
Key words: Anti-inflammatory agents, non-steroidal; Aspirin; Coronary artery disease; Desensitization, immunologic
 

• Allergy Asthma Immunol Res >
• v.5(3); May 2013 >
• PMC3636445

Allergy Asthma Immunol Res. 2013 May; 5(3): 119–128.

Published online 2013 February 4. doi:  10.4168/aair.2013.5.3.119

PMCID: PMC3636445

Vitamin D, the Cutaneous Barrier, Antimicrobial Peptides and Allergies: Is There a Link?

Elisabeth Roider, Thomas Ruzicka, and Jürgen Schauber

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Abstract

Atopic diseases such as atopic dermatitis (AD) are very common in industrialized countries. Up to 15%-30% of all children and 2%-10% of all adults suffer from AD. Already in early disease stages, a defective epidermal barrier is known to contribute to the pathogenesis of AD. Central elements in the epidermal barrier are antimicrobial peptides (AMPs), which are secreted by keratinocytes, sweat gland cells but also infiltrating immune cells. AMPs function as endogenous antibiotics and are able to kill bacteria, viruses, and fungi. Furthermore AMPs act as immune modulators with effects on the innate and adaptive immune system. The probably best studied AMPs in human skin are the defensins and cathelicidin. In atopic diseases the functions of AMPs such as cathelicidin might be impaired and microbial superinfections could serve as cofactors for allergic sensitization. Hence, induction of AMPs could be beneficial in these patients. Cathelicidin which is often referred to its peptide form hCAP18 or LL-37 can be induced by ultraviolet light B (UVB) irradiation and is upregulated in infected and injured skin. The cathelicidin gene carries a vitamin D response element and the vitamin D pathway could therefore be targeted for cathelicidin regulation. As the development and course of atopic diseases might be influenced by vitamin D signaling these pathomechanisms could explain the growing evidence connecting vitamin D to allergic diseases, including AD, allergic rhinitis, food allergies and asthma. In this review the role of vitamin D and the AMP cathelicidin in the pathogenesis of atopic diseases with impaired barrier function will be discussed.

Keywords: Vitamin D, atopic dermatitis, allergy, cutaneous barrier, antimicrobial peptides, cathelicidin

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Articles from Allergy, Asthma & Immunology Research are provided here courtesy of Korean Academy of Asthma, Allergy and Clinical Immunology and Korean Academy of Pediatric Allergy and Respiratory Disease

 

Clinical, Cosmetic and Investigational Dermatology

Skin-protective effects of a zinc oxide-functionalized textile and its relevance for atopic dermatitis

Original Research

(431) Total Article Views

Authors: Wiegand C, Hipler U-C, Boldt S, Strehle J, Wollina U

Published Date May 2013 Volume 2013:6 Pages 115 - 121

DOI: http://dx.doi.org/10.2147/CCID.S44865

Received:	06 March 2013
Accepted:	11 April 2013
Published:	06 May 2013

Cornelia Wiegand,¹ Uta-Christina Hipler,¹ Sebastian Boldt,² Joachim Strehle,² Uwe Wollina^2
1Department of Dermatology, University Medical Center Jena, Jena, Germany; ²Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany

Abstract: Atopic dermatitis (AD) is a chronic inflammatory disease characterized by the impairment of the skin-barrier function, increased oxidative cellular stress, and bacterial colonization. Hence, medical therapies of AD aim to control infection, reduce inflammation, and restore skin-barrier function by use of topical and systemic antibacterial drugs, topical corticosteroids, topical calcineurin inhibitors, and moisturizers. Textiles have the longest and most intense contact with the human skin, and functional textiles with intrinsic properties such as antioxidative capacity and antibacterial activity have been gaining in importance in medical applications. Specially designed textiles may support AD treatment and improve quality of life of AD. Here, we investigated the role of ZnO-functionalized textile fibers in the control of oxidative stress in AD in vitro and in vivo. In addition, the antibacterial effect and biocompatibility of the Zn textile was evaluated in vitro. We observed a rapid improvement of AD severity, pruritus, and subjective sleep quality when AD patients wore the ZnO textiles overnight on 3 consecutive days. This is possibly due to the high antioxidative capacity of the ZnO textile, as well as the allocation of strong antibacterial activity. Moreover, it was shown that the ZnO textiles possess very good biocompatibility and were well tolerated by AD patients.

Keywords: atopic dermatitis, antibacterial activity, biocompatibility, functionalized textiles, oxidative stress

Review

Combination bronchodilator therapy in the management of chronic obstructive pulmonary disease

Donald P Tashkin and Gary T Ferguson

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Respiratory Research 2013, 14:49 doi:10.1186/1465-9921-14-49

Published: 8 May 2013

Abstract (provisional)

Chronic obstructive pulmonary disease (COPD) represents a significant cause of global morbidity and mortality, with a substantial economic impact. Recent changes in the Global initiative for chronic Obstructive Lung Disease (GOLD) guidance refined the classification of patients for treatment using a combination of spirometry, assessment of symptoms, and/or frequency of exacerbations. The aim of treatment remains to reduce existing symptoms while decreasing the risk of future adverse health events. Long-acting bronchodilators are the mainstay of therapy due to their proven efficacy. GOLD guidelines recommend combining long-acting bronchodilators with differing mechanisms of action if the control of COPD is insufficient with monotherapy, and recent years have seen growing interest in the additional benefits that combination of long-acting muscarinic antagonists (LAMAs), typified by tiotropium, with long-acting beta2-agonists (LABAs), such as formoterol and salmeterol. Most studies have examined free combinations of currently available LAMAs and LABAs, broadly showing a benefit in terms of lung function and other patient-reported outcomes, although evidence is limited at present. Several once- or twice-daily fixed-dose LAMA/LABA combinations are under development, most involving newly developed monotherapy components. This review outlines the existing data for LAMA/LABA combinations in the treatment of COPD, summarizes the ongoing trials, and considers the evidence required to inform the role of LAMA/LABA combinations in treatment of this disease.

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Original article | Published 18 April 2013, doi:10.4414/smw.2013.13788
Cite this as: Swiss Med Wkly. 2013;143:w13788

Thrombocytopenia as a mortality risk factor in acute respiratory failure in H1N1 influenza

Juan Carlos Lopez-Delgado^a, Assumpta Rovira^b, Francisco Esteve^a, Nicolás Rico^b, Rafael Mañez Mendiluce^a , Josep Ballús Noguera^a, Julián Berrade^b

^a Hospital Universitari de Bellvitge, Intensive Care Department, IDIBELL (Institut d’Investigació Biomèdica Bellvitge; Biomedical Investigation Institute of Bellvitge), L’Hospitalet de Llobregat, Barcelona, Spain
^b Hospital General de L’Hospitalet, Intensive Care Department, CSI (Consorci Sanitari Integral), L’Hospitalet de Llobregat, Barcelona, Spain

Summary

BACKGROUND: A small proportion of patients with influenza H1N1 rapidly develop acute respiratory failure and are a problem for intensive care units (ICUs). Although certain clinical risk factors have been identified, few measurable biochemical/haematological markers able to predict poor outcome have been reported. The aims of the present report are to show which variables on and during admission are associated with increased in-hospital mortality in patients admitted to the ICU with acute respiratory failure due to H1N1 influenza.

METHODS: A prospective observational study at two ICUs was carried out between August 2009 and March 2011. The study period covered two waves of pandemic influenza A H1N1 in Spain. Clinical and laboratory data on and during ICU admission were recorded for the purpose of analysis.

RESULTS: Sixty patients with acute respiratory failure due to H1N1 influenza were admitted during the period described above; 63.3% (n = 38) were male and the mean age was 49.2 ± 14 years. Regarding comorbidities, 46.7% (n = 28) were smokers, 38% (n = 23) had hypertension, 30% (n = 18) had a body mass index (BMI) >30 kg/m², 30% (n = 18) had chronic obstructive pulmonary disease and 26% (n = 16) had cardiac insufficiency; 16.6% (n = 10) had bacterial co-infection, 70% (n = 42) required invasive mechanical ventilation and 48.3% (n = 29) non-invasive mechanical ventilation. Mortality was 20% (n = 12). Comparing survivors with non-survivors, univariate analysis revealed significant differences in BMI, creatinine, haemoglobin, platelets, arterial pH, pCO₂, and the rate of bacterial co-infection. In the multivariate analysis, only the presence of lower platelet count was statistically significant (214 ± 101 vs 113 ± 82 ×10⁹/L; p = 0.009). Patients with thrombocytopenia showed a lower in-hospital survival rate (55%vs92.5%; Log Rank = 0.008).

CONCLUSIONS: Thrombocytopenia could be valuable marker of in-hospital mortality in patients with respiratory failure due to H1N1 influenza in the ICU scenario.

Key words: thrombocytopenia; influenza H1N1; acute respiratory failure; Intensive Care Units; in-hospital mortality; risk factors

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Research article

The microbiome of chronic rhinosinusitis: culture, molecular diagnostics and biofilm detection

Sam Boase, Andrew Foreman, Edward Cleland, Lorwai Tan, Rachel Melton-Kreft, Harshita Pant, Fen Z Hu, Garth D Ehrlich and Peter-John Wormald

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BMC Infectious Diseases 2013, 13:210 doi:10.1186/1471-2334-13-210

Published: 8 May 2013

Abstract (provisional)

Background

Bacteria and fungi are believed to influence mucosal inflammation in chronic rhinosinusitis (CRS). However their presence and relationship to disease is debated. This study used multiple detection methods to compare microbial diversity and microbial abundance in healthy and diseased sinonasal mucosa. The utility of contemporary detection methods is also examined.

Methods

Sinonasal mucosa was analyzed from 38 CRS and 6 controls. Bacterial and fungal analysis was performed using conventional culture, molecular diagnostics (polymerase chain reaction coupled with electrospray ionization time-of-flight mass spectrometry) and fluorescence in situ hybridization.

Results

Microbes were detected in all samples, including controls, and were often polymicrobial. 33 different bacterial species were detected in CRS, 5 in control patients, with frequent recovery of anaerobes. Staphylococcus aureus and Propionibacterium acnes were the most common organisms in CRS and controls, respectively. Using a model organism, FISH had a sensitivity of 78%, and a specificity of 93%. Many species were detected in both CRS and controls however, microbial abundance was associated with disease manifestation.

Conclusions

This study highlights some cornerstones of microbial variations in healthy and diseased paranasal sinuses. Whilst the healthy sinus is clearly not sterile, it appears prevalence and abundance of organisms is critical in determining disease. Evidence from high-sensitivity techniques, limits the role of fungi in CRS to a small group of patients. Comparison with molecular analysis suggests that the detection threshold of FISH and culture is related to organism abundance and, furthermore, culture tends to select for rapidly growing organisms.

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