A B S T R A C T S
SUNDAY, 27 MAY 2018 T P S 0 1
A S T H M A : F R O M B E N C H T O B E D S I D E
0630
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Development and characterization of
effective DNAzymes against human rhinoviruses
Potaczek DP
1; Unger SD
1; Zhang N
2; Taka S
3; Michel S
4;
Akdag N
1; Lan F
2; Helfer M
4; Hudemann C
1; Eickmann M
5;
Skevaki C
1; Megremis S
6; Sadewasser A
4;
Alashkar Alhamwe B
1; Alhamdan F
1; Akdis M
7;
Edwards MR
8; Johnston SL
8; Akdis CA
7; Becker S
5;
Bachert C
9; Papadopoulos NG
10; Garn H
1; Renz H
11Institute for Laboratory Medicine, the member of German Center for
Lung Research (DZL) and International Inflammation (in‐FLAME) Network, Worldwide Universities Network (WUN), Philipps‐University Marburg, Marburg, Germany; PreDicta Consortium; John Paul II Hospital, Krakow, Poland, Marburg, Germany;2Upper Airway Research
Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; PreDicta Consortium, Ghent, Belgium;3Allergy
and Clinical Immunology Unit, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece; PreDicta Consortium, Athens, Greece;4Secarna Pharmaceuticals GmbH & Co KG, Planegg,
Germany, Planegg, Germany;5Institute of Virology, Philipps‐University Marburg, Marburg, Germany, Marburg, Germany;6Division of Infection, Inflammation and Respiratory Medicine, University of Manchester, Manchester, United Kingdom; PreDicta Consortium, Manchester, United Kingdom;7Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne‐Center for Allergy Research and Education (CK‐CARE), Davos, Switzerland; PreDicta Consortium, Davos, Switzerland;8Airway Disease Infection
Section, National Heart and Lung Institute (NHLI), Imperial College London, London, United Kingdom; Medical Research Council (MRC) and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom; PreDicta Consortium, London, United Kingdom;9Upper
Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium, Ghent, Belgium;10Allergy and
Clinical Immunology Unit, 2nd Pediatric Clinic, National and
Kapodistrian University of Athens, Athens, Greece; Division of Infection, Inflammation and Respiratory Medicine, University of Manchester, Manchester, United Kingdom; PreDicta Consortium, Athens, Greece
Background:
Infections with human rhinoviruses (RVs) are respon-sible for millions of common cold episodes and the majority of asthma exacerbations, especially in childhood. No drugs specifically targeting RVs are available. We aimed to develop a specific antirhi-noviral therapeutic based on DNAzyme technology.Method:
A total of 226 candidate DNAzymes were designed against highly conserved regions of RV RNA genome, 5 ’‐untrans-lated (5’‐UTR) and cis‐acting replication element (CRE), by use of three representative strains, RVA1,‐A16, and ‐A29. All DNAzymes were screened for their cleavage efficiency against in vitro‐ expressed viral RNA. Those showing any catalytic activity were subjected to bioinformatic analysis of their reverse complementarity to (coverage of) 322 published rhinoviral genomic sequences. Fur-ther molecular optimization was conducted for most promisingcandidates. Cytotoxic and off‐target effects were excluded in HEK293‐cell‐based systems. Antiviral efficiency was analyzed in infected human bronchial BEAS‐2B cells and ex vivo‐cultured human sinonasal tissue.
Results:
Screening phase generated DNAzymes characterized by either good catalytic activity or by high RV strain coverage but no single molecule representing a combination of those two features. Modifications in length of the binding domains of two lead candi-dates, Dua‐01(‐L12R9) and Dua‐02(‐L10R11), improved their cleav-age efficiency to an excellent level with no loss in strain covercleav-age (about 98%). Both DNAzymes showed highly favorable cytotoxic/off‐ target profiles. Subsequent testing of Dua‐01‐L12R9 in BEAS‐2B cells and sinonasal tissue demonstrated its significant antiviral effi-ciency.Conclusion:
Effective and specific management of RV infections with Dua‐01‐L12R9 might be useful in preventing asthma exacerba-tions.0631
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Characterisation of Aspergillus niger
and A. tubingensis related allergens relevant to
asthma
Rick E
1; Wardlaw AJ
1; Cousins D
1; Satchwell J
1; Baxter B
1;
Craner M
1; Raith M
2; Pfeiffer S
2; Noebauer K
3;
Razzazi-Fazeli E
3; Bottrill AR
4; Pashley CH
1; Swoboda I
21Institute for Lung Health, Department of Infection, Immunity and
Inflammation, University of Leicester and Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom;2Immunology
Research Group, Section Biotechnology, FH Campus Wien, University of Applied Sciences, Campus Vienna Biocenter, Vienna, Austria;3VetCore Facility for Research, University of Veterinary Medicine Vienna, Vienna, Austria;4PNACL facility, University of Leicester, Leicester, United Kingdom
Background:
Colonisation and IgE sensitisation to Aspergillus fumi-gatus is associated with decreased lung function in asthmatics. Our recent high‐throughput sequencing data of the mycobiome in the lungs of patients with asthma and healthy subjects showed that higher quantities of fungal sequences from Aspergillus section Nigri were present in the lungs of asthmatics compared to healthy con-trols. This suggests that these black fungi could contribute to the asthma phenotype.Method:
To get a better understanding of this contribution, we investigated the IgE response to well characterised clinical isolates from two strains of the black fungi, which were most frequentlyrecovered from clinical samples of asthmatics, A. tubingensis and A. niger. Strains from A. fumigatus served as a positive control. Protein extracts of these fungi were used for immunoblots performed with sera from asthmatics with varying IgE‐levels to A. fumigatus (0‐ 66 kU/L, as determined by ImmunoCAP).
Results:
Immunoblots showed that only those patients who were highly sensitised to A. fumigatus (≥17 kU/L) showed IgE‐reactivity towards Aspergillus section Nigri, though the reaction was weaker than to the A. fumigatus controls. Six allergens with molecular weights of 15, 18, 23, 35, 50 and 100 kDa were recognized in Aspergillus section Nigri. Cross‐reactivity between the different Asper-gillus species was indicated by inhibition blots, where A. fumigatus proteins could inhibit IgE‐reactivity towards Aspergillus section Nigri allergens. To identify the cross‐reactive allergens, inhibition immuno-blots were performed with available recombinant allergens of A. fu-migatus (Asp f 3, 4 and 6). The fact that Asp f 3 and 6 inhibited IgE‐ binding to the three low molecular weight proteins allowed identifi-cation of these proteins as novel cross‐reactive black fungi allergens. Peptide mass fingerprinting, performed to identify the remaining Aspergillus section Nigri allergens, yielded many potential candidates, which will be narrowed down by other techniques such as two‐ dimensional IgE immunoblots or immunoprecipitation followed by mass spectrometry analysis.Conclusion:
In conclusion, several allergens of the Aspergillus sec-tion Nigri were identified with some cross‐reactivity to allergens found in A. fumigatus. Further characterisation of these allergens is ongoing.0633
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Preventive and therapeutic effects of
vitamin D in a mouse model of allergic asthma
Lim DH
1; Kim JH
1; Cho SW
21Department of Pediatrics and Environmental Health Center for Allergic
Diseases, Inha University Hospital, Incheon, South Korea;2Department
of Family Medicine, Inha University Hospital, Incheon, South Korea
Background:
It is known that vitamin D has anti‐allergic effects to control the inflammation of asthma. We investigated whether vita-min D has anti‐allergic and anti‐inflammatory effects on sensitization and challenge stage of asthma development in murine model.Method:
Five groups of mice were designed according to ovalbu-min (OVA) and vitaovalbu-min D (VD) adovalbu-ministration: control group, OVA group, preventive VD group (100 ng of VD injection before OVA sensitization), therapeutic VD group (100 ng of VD injection after OVA challenge), both VD group (100 ng of VD injection before OVA sensitization and after OVA challenge). Each group is evaluated for allergic and inflammatory markers such as airway hyper ‐responsive-ness (AHR), cell counts in bronchoalveolar lavage fluid (BALF), cytokines in BALF, total IgE and OVA‐specific IgE in BALF. Cytokines in lung lysate and major basic protein stained cell (eosinophil) in lung tissue are also evaluated.Results:
At the concentration of 50 mg/mL of methacholine, AHR was lesser in therapeutic VD and both VD group than in OVA group. Eosinophil, neutrophil, IL‐5 in BALF and IL‐4, TGF‐β in lysate were decreased by preventive, therapeutic and both VD administration compared to OVA group. While, lymphocyte, macrophage, IL‐4 in BALF and IL‐5 in lysate were decreased by therapeutic and both VD administration and not influenced by preventive VD use. These anti‐ allergic effect of VD was most distinct when VD was administered for both preventive and therapeutic purpose.Conclusion:
According to these results VD may have the preven-tive and therapeutic effects on development and exacerbation of asthma in murine model.0634
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Toxicity and adjuvant effect of silver
nanoparticles in airway allergic inflammation
Park KH; Oh E; Han H; Park YH; Lee SC; Park J
Division of Allergy and Immunology, Department of Internal Medicine and Institute of Allergy, Yonsei University College of Medicine, Seoul, South Korea
Background:
The effects of silver nanoparticles (SNPs) on airway disease have been remained as a controversy. In this study, we investigated the effect of inhalation toxicity on the size of silver nanoparticles and the effect on bronchial allergic inflamma-tion.Method:
Female BALB/c mice and two different sized of SNPs (10 nm and 100 nm) were used for this study. First, to evaluate toxi-city of SNPs itself, particles were administered intra‐nasally for 4 weeks. Second, to evaluate the adjuvant effects of SNPs, we administered SNPs with or without ovalbumin (OVA) intra‐nasally for 4 weeks. Body weight, airway hyper‐responsiveness (AHR), cytology of broncho‐alveolar lavage fluid (BALF), histology with immunochem-ical staining of lung, immunologic cytokines (interleukin‐5, 13 and interferon‐gamma), OVA—specific immunoglobulin titers (IgE, IgG1, IgG2a) were measured.Results:
Intra‐nasal administration of SNPs (both 10 nm and 100 nm) alone did not make difference in AHR, histology, Th2‐ related cytokines between sham and SNP administered groups. But 100 nm SNPs induced significant increase in the number of total inflammatory cells, macrophages and neutrophils in BALF. Body weights of SNP‐treated groups were less than sham group which was not significant. OVA specific IgG1 were elevated significantly in the 100 nm SNP group compared with 10 nm SNP group. In the second experiment model, nasal administration of OVA alone could not induce asthma. However, when administered with both OVA and SNP 100 nm particles, asthmatic bronchial inflammation was marked. Peri‐bronchial and peri‐vascular infiltration of eosinophils, neutrophils and macrophages were significant. Respiratory goblet cell hyperplasia was observed and specific IgG1, G2a to OVA were also elevated. The results of 100 nm SNPs were more prominent thanthose of the 10 nm group. However, AHR and body weight did not show statistical difference between groups.
Conclusion:
SNPs can act as adjuvants in bronchial allergic inflam-mation development in murine model. The effects are more promi-nent at 100 nm SNPs than at 10 nm SNPs.0635
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The effects and uptake of gold
nanoparticles in asthmatic mice
Harfoush S
1; Omlor A
1; Ewen R
1; Le DD
1; Schlicker J
1;
Heck S
1; Bals R
2; Nguyen J
3; Dinh TQ
41
Department of Experimental Pneumology and Allergology, Saarland University Faculty of Medicine., Homburg/saar, Germany;2Department of Internal Medicine V, Pneumology, Allergology and Respiratory Critical Care Medicine, Saarland University Faculty of Medicine., Homburg/saar, Germany;3Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, Suny Buffalo, New York, United States;
4
Department of Experimental Pneumology and Allergology, Saarland University Faculty of Medicine and Department of Internal Medicine V, Pneumology, Allergology and Respiratory Critical Care Medicine, Saarland University Faculty of Medicine, Homburg/saar, Germany
Background:
Nanoparticles are increasingly used as an advanced strategy for drug delivery and different medical therapies. The impact of nanomaterials in healthy and asthmatic models is still under investigation. Our aim is to investigate the uptake, influence and distribution of nanoparticles in BALB/c ovalbumin (OVA) asthma mouse model.Method:
Dispersions of citrate/tannic‐acid‐coated (citrated) 5 nm gold nanoparticles and polyethylene‐glycol‐coated (PEGylated) are given to asthma and control groups intranasally. Allergic airway resis-tance and airway inflammation are measured. Nanoparticle uptake into extrapulmonary organs is quantified by inductively coupled plasma mass spectrometry.Results:
The asthmatic precondition augments nanoparticle uptake. Furthermore, systemic uptake is more elevated for PEGylated gold nanoparticles compared to citrated nanoparticles. We also revealed that nanoparticles prevent both airway hyperreactivity and inflamma-tory infiltrates, especially citrated gold nanoparticles. PEGylated and Citrated NP‐treatments in allergic asthma mice models significantly inhibit a strong increase of the macrophage population. More pre-cisely, we found out that both types of NPs do not make any effect on M1 and M2 macrophages polarization.Conclusion:
Gold nanoparticles may have antiinflammatory effects in asthmatic mice. Asthmatic situations raises systemic uptake of gold nanoparticles.0637
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Epidemiological survey of asthma based
on the data of health insurance claims and
specific health checkups for metabolic syndrome
Tomita Y
1; Fukutomi Y
2; Irie M
3; Azekawa K
4; Shimoda T
5;
Okada C
6; Nakamura Y
7; Hasegawa Y
8; Taniguchi M
21Clinical Research Center for Allergy and Rheumatology, Sagamihara
National Hospital/Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Sagamihara/Nagoya, Japan;
2Clinical Research Center for Allergy and Rheumatology, Sagamihara
National Hospital, Sagamihara, Japan;3Nihon Medical Insurance
Institute Ltd., Tokyo, Japan;4MHI Co., Ltd., Tokyo, Japan;5SanRemo
Rehabilitation Hospital, Nagasaki, Japan;6Headquarters, National
Hospital Organization, Tokyo, Japan;7Medical Center for Allergic and
Immune Diseases, Yokohama City Minato Red Cross Hospital, Yokohama, Japan;8Department of Respiratory Medicine, Nagoya
University Graduate School of Medicine, Nagoya, Japan
Background:
Although many studies conducted in Western coun-tries have shown that obesity is a risk factor for incident asthma, few reports have occurred in Asian countries. Although metabolic syndrome is a well‐known risk factor for many non‐communicable diseases, its contribution to asthma remains controversial. In 2008, metabolic syndrome‐specific health checkups were started for all res-idents with public health insurance coverage in Japan. We aimed to clarify the relationships of obesity and metabolic syndrome with inci-dent asthma among middle‐aged adults in Japan.Method:
Data were collected and analyzed from health insurance claims and metabolic syndrome‐specific health checkups at three large health insurance societies from April 2011 to March 2015. Among the subjects without asthma from April 2011 to March 2013, multivariate logistic regression analyses were performed to investigate the relationships between obesity and metabolic syn-drome in the 2012 fiscal year compared with incident asthma from April 2013 to March 2015 (n = 9888). In order to compare the impact of obesity measures and metabolic syndrome on incident asthma, both obesity measures and metabolic syndrome were simul-taneously entered into the statistical models as independent vari-ables. All analyses were separately performed in men and women considering possible sex differences in relationship between obesity and risk of asthma. A P value of<0.05 was considered statistically significant.Results:
Two hundred thirteen out of 5915 men and 211 out of 3973 women developed asthma. In women, BMI 25‐29.9 kg/m2 or≥30 kg/m2
, waist circumference ≥90 cm, and waist‐to‐height ratio ≥0.5 were shown to be significant risk factors for incident asthma, with adjusted odds ratios (95% CI) of 1.93 (1.35‐2.76), 2.24 (1.23‐ 4.09), 1.89 (1.30‐2.75), and 1.54 (1.16‐2.05), respectively. The signifi-cance remained even after adjustment for metabolic syndrome. To be classified as metabolic syndrome preliminary group (abdominal obesity plus one of the following: hyperglycemia, hypertension, or dyslipidemia) was shown to be a risk factor for incident asthma only in women, but the statistical significance disappeared after adjust-ment for BMI. In addition, there was no significant relationship
(either in men or women) between metabolic syndrome and incident asthma.
Conclusion:
This study confirmed the significance of obesity as a risk factor for incident asthma. Moreover, obesity appeared to be a stronger risk factor than metabolic syndrome.0638
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Relationship between helminth
infection, blood eosinophils and asthma
symptoms in a rural community from the tropics
Pe
ñaranda D; Alvarez L; Sierra N; Lopez J; Zakzuk J;
Caraballo L
Institute for Immunological Research. University of Cartagena, Cartagena, Colombia
Background:
Immune response to helminths shares many features with the allergic response. In tropical regions where helminths are highly prevalent, asthma is still a major public health burden. Large clinical cohorts suggest that high blood eosinophils (HBE=>400 cells/ mm3) are associated with asthma exacerbations. However, theasso-ciation between HBE and asthma severity in rural communities with prevalent helminthic infections is unclear.
Method:
Patients with wheezing symptoms in the last year living in a rural tropical community (Santa Catalina, Colombia) where hel-minths are highly prevalent, were recruited for this study. Blood eosinophils were assessed by complete blood count. Parasitic infec-tion was evaluated with two serial coprological exams (Kato‐Katz method) and skin prick tests were conducted to determine reactivity to Ascaris.Results:
Seventy‐three patients (mean age: 21; range: 2‐64 years old) were recruited in this study. A. lumbricoides and T. trichuria active infection (47.9% and 16.4%, respectively) were not related to age or gender. A positive SPT to Ascaris extract, ABA‐1 and D. pteronyssinus was observed in 23%, 18.4% and 34.2%, respec-tively. Mean eosinophil count was 621 cells/mm3; 43.9% had HBE.Rate of patients with at least one emergency department visit was 61.9% and hospitalization, 21.9%. Blood eosinophil counts (as a con-tinuous variable) were inversely associated with age (P = 0.03) and higher in helminth infection (P = 0.002). In crude univariate analysis, exacerbations (ER and/or hospitalization) were associated with age (OR: 0.96; 95% CI: 0.93‐0.99, P < 0.01) and HBE (OR: 2.9; 95%CI: 1.1‐7.8, P = 0.04), but not with helminth infection. For a better defi-nition of asthma, multivariate analysis done in those >7 years old indicated that HBE, helminth infection and positive Ascaris SPT were not associated with asthma exacerbations.
Conclusion:
Uncontrolled asthma is common in rural places of the tropics. Since helminth infection influences eosinophilia, the clinical value of HBE to predict exacerbations is limited in helminth‐endemic populations.0641
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Association of 19
‐bp del/ins dhfr
polymorphism with bronchial asthma
Castro MC
1; Ferreira J
2; Sarmento D
2; Carvalho C
2;
Matos A
2; Bicho M
21CHLN
‐Immunoallergy; Lisbon Medical School‐Genetic Department, Lisboa, Portugal;2Lisbon Medical School
‐Genetic Department, Lisboa, Portugal
Background:
The bioavailability of NO and endothelial homeosta-sis depends on the functional polymorphism of 19‐bp Del/Ins within intron‐1 of DHFR (Dihydrofolate reductase enzyme) (rs70991108) that could interfere in the regeneration of BH4 (tetrahydrobiopterin) from BH2 (7,8‐dihydrobiopterin) and contributes to endothelial dysfunc-tion in asthma.Method:
Asthmatics (n = 123) compared with control group (n = 50).The polymorphism was analyzed by PCR. Control of asthma assessed by (ACQ7 and PAQLQ). Statistical analysis with SPSS 23.0 establishing a significance level of P< 0.05.Results:
There are 80 women and 43 males in asthmatics and 39 women and 11 males in controls (P = 0.137). In asthmatics: age (x ± SD): 38.26 ± 19.24; and in control group: age (x ± SD): 51.50 ± 13.34. The genotype frequencies in asthmatics are: DD (6.5%); ID (66.7%); II (26.8%); in control group: DD (12.0%); ID (64.0%); II (24.0%); there is no statistical difference between groups (P = 0.478). The allelic frequencies in asthmatics are: allele D (39.8%); allele I (60.2%); in control group: allele D (44%); allele I (56%); there is no statistical difference between groups (P = 0.476). The genotype frequencies in the uncontrolled asthmatics are: DD (0.0%); ID (61.1%); II (38.9%); in the controlled asthmatics are: DD (9.4%); ID (68.2%); II (22.4%); there is statistical difference between groups (P = 0.047). Genotypes ID and II are more frequent in the uncontrolled asthmatics. The allelic frequencies in the uncontrolled asthmatics are: allele D (30.6%); allele I (69.4%); in the controlled asthmatics are: allele D (43.5%); allele I (56.5%); there is a trend to have differences between groups (P = 0.059). Allele I is more fre-quent among uncontrolled asthmatics.The uncontrolled asthmatics are older than the controlled asthmatics (P< 0.001). There is no differences in gender distribution (P = 0.903).
The genotype II confers a risk of being uncontrolled asthmatic of 2.950 times when compared with controlled asthmatics and adjusted for age: ORb: 2.950 [1.117
‐7.789]; P = 0.029.
Conclusion:
In this hospital based population we have demon-strated that this polymorphism is related with more severe asthma. Uncontrolled asthmatic patients are more frequent among those that express allele I. Homozygous II confers a risk of 3 times of being uncontrolled asthmatic when adjusted for age.0643
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The advantage of periostin as the
traditional markers of allergic inflammation in
bronchial asthma
Masalskiy SS
1; Kalmykova AS
1; Ukhanova OP
1; Smolkin YS
21Stavropol State Medical University, Stavropol, Russia;2SCCC of
Allergology and Immunology Moscow, Moscow, Russia
Background:
Allergic asthma very common phenotype in child-hood. Introduction to clinical practice of monoclonal antibodies to IgE ‐ omalizumab, IL 5 ‐ reslizumab and in the future lebrikizumab (anti IL 13) requires the selection of patients for therapy. Effector cells and serum proteins are proposed for the role of markers of specific inflammation. Serum periostin (SP) is a protein produced by fibroblasts under the action IL 13. It is known, that SP predictor of lebrikizumab efficacy in clinical studies in adult patients.Method:
The study included 75 children (6‐17 years) with uncon-trolled asthma. The group of mild asthma ‐ 51 people, moderate asthma‐ 24 people. The patients were examined: serum eosinophils (EOS), SP, spirometry. The cut off 0.4× 109 was chosen for higheosinophilia. Patients are divided into 2 groups with high and low periostin by median ‐ Me (Q1; Q3). Analyses included descriptive statistics, logistic regression, Spearman correlation.
Results:
The level of SP was in the range 0.17‐22.6 ng/mL, Me— 3.93 (1.96; 7.80) ng/mL. In the group of mild asthma patients with high SP ‐ 40.0%, in the group with moderate periosteum 72.7% (P = 0.02). Medians for mild asthma was 3.14 (1.80; 5.42), for mod-erate asthma 5.71 (3.52; 10.53). Differences are significant (U = 790.5, P = 0.003).Patients with serum EOS> 0.4 × 109 in the group with mild and
moderate asthma were not statically different (29.2% vs 33.3%, P = 0.79).
There were no significant Spearman correlation between eosinophils, SP, FEV1, FEV1/FVC in children with asthma.
Logistic regression analysis showed that SP is the best predictor sev-ere asthma, odds ratio 1.22 CI 95% (1.07‐1.42), P = 0.004.
Conclusion:
Serum Periostin significant predictor of severe and moderate asthma. IL13—associated is widely represented in the chil-dren's population. Monoclonal antibodies to IL 13 may be promising for the treatment of childhood asthma.SUNDAY, 27 MAY 2018 T P S 0 2
C L I N I C A L A S P E C T S O F A S T H M A
0645
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Asthma in a gas station worker
Cosgaya Ceballos A; Rial Prado MJ; Valverde Monge M;
Fernández-Nieto M; Sastre Domínguez J
Fundación Jiménez Díaz, Madrid, Spain
Background:
Although several large epidemiological studies have demonstrated a strong association between exposure to motor vehi-cle traffic emissions and allergic symptoms and reduced lung func-tion, the evidence for the development of allergic sensitization from hydrocarbons is less abundant than for the aforementioned associa-tionsMethod:
We present a 35‐year‐ old patient with allergy and sea-sonal asthma in childhood. Worker of a gas station, required long sick leaves during which he remained asymptomatic, worsening with serious exacerbations in the work environment despite treatment with high doses of ICS‐LABA and rescue SABA.We performed a forced spirometry with bronchodilation test at baseline and the study of occupational asthma without working after discontinuing the treatment: non‐specific bronchial provocation with methacholine before and after the specific bronchial provocation and specific bronchial provocation in the inhalation chamber with hydro-carbons.
Results:
Baseline spirometry: FVC 86%, FEV1 86% TI 83 FEF 75/ 25 78.1%Occupational asthma study:
• Non-specific bronchial provocation with methacholine after specific bronchial provocation: PC 20 1.43 mg/mL
• Non-specific bronchial provocation with methacholine after specific bronchial provocation: PC 20 0.5 mg/mL
• Specific bronchial provocation in inhalation chamber with hydrocarbons (diesel and gasoline): Drop in the FEV1 of 18.5% at the end of the test maintained for 6 hours, reverts with B2 agonist.
Conclusions:
Occupational asthma, by direct inhalation of fuel, has not been extensively studied in the literature. We confirmed the diagnosis of presumption of moderate‐severe persistent asthma with exacerbation of occupational origin by hydrocarbons in a gas station worker by occupational asthma study in the inhalation chamber.0646
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Case
‐report: The combination of
recurrent papillomatosis of the trachea and
bronchial asthma
Korovkina ES
Scientific‐Research Institute of Vaccines and Sera n.a. I.I. Mechnikov, Moscow, Russia
Case report:
The patient (33‐y.o. woman) appealed with com-plaints of dyspnea, cough and sharp difficulty breathing at swallow-ing. The patient gives history of the bronchial asthma since 2001 with basic treatment by formoterol/budesonide 4.5/160μg; since 2012 she had pollinosis. Early in April 2014 the symptoms of sea-sonal rhinoconjunctivitis, dry paroxysmal cough, hoarseness have appeared, the basic therapy didn't give effect. The spirometry was not run during the pulmonologist visit, the patient condition was diagnosed as neurotic, the anxiolytics were prescribed. During the treatment the symptoms increased, discomfort during swallowing, distant whistling rales in the chest has joined; inhalation of for-moterol/budesonide 4.5/160μg and short‐acting β2‐agonists gave not effect. During the examination heard the distant wheezes over the trachea and larynx, there was the participation of auxiliary muscles in breathing; during the auscultation there were a lot of buzzing wheezing, which was regarded as wired. In conducting of spirometry the data for the obstructive changes was not received: FEV1 113%, FVC 120%, the sample with salbutamol 400μg was negative. The discrepancy between the clinical symptoms and data of physical and instrumental methods of examination were taken in account and the bronchoscopic examination was run. Data of the bronchoscopy: in the middle third of the trachea is visualized tumor formation up to 1.5‐2 cm in diameter with new formations up to 2 mm in the mucosa joined to the basic growth. The removal of papillomas with electropathy was run under local anesthesia; small papillomas were removed with use of photodynamic therapy. After operation the symptoms fully has stopped. The spirometry figures were in the nor-mal range (FEV1 135%, FVC 134%). It was the reason for basic ther-apy changes: the use of formoterol/budesonide of 4.5/80μg in SMART. Resume: lack of attention to anamnesis data and knowledge according to the problem of primary care physicians were cause for untimely necessary instrumental examinations and, as a result, pre-scribing of the various medicamental treatments without effect. It caused further growth and spread of papillomas. This case‐report demonstrates the necessity for regular monitoring of bronchial per-meability by spirometry and/or peak flow as well as long‐term obser-vations of patients by one doctor. This allows to identify the symptoms changes and apply all necessary diagnostic and therapeu-tic steps.0647
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Effects of viral infections for asthma
development in wheezy children
Ulusoy Severcan E
1; Kartal Ozturk G
1; Eski A
1;
Eren Akarcan S
1; Gulen F
1; Demir E
11Ege University Faculty of Medicine, Department of Pediatric
Immunology and Allergy, Izmir, Turkey
Background:
Viral infections especially rhinovirus and respiratory syncytial virus (RSV) infections may affect asthma development in wheezy children. In this study we aimed to evaluate the effects of viral infections on asthma development.Method:
We evaluated 33% girl, 67% boy 1013 atypic (30%) and typic (70%) wheezy children's respiratory virus panels for viral infec-tions retrospectively.Results:
Average ages, ages of first attack and attack times per year were 11 ± 8 years, 26 ± 14 months, 4 attack/year respectively. Half of the patients had attacks at winter. We isolated virus in 45.2% of the patients (54% typic, 46% atypic). The most common viruses were rhinovirus (16.2%), RSV (15.8%), parainfluenza virus (8.3%), influenza A virus (8.3%), adenovirus (3.9%). There wasn't any statistical difference between atypic and typic wheezy patients according to viruses. Virus was isolated in 45.5% of the typic wheezy patients. The most common viruses in these patients were rhinovirus (17.2%), RSV (14.8%) and parainfluenza virusForty percent of these wheezy children developed asthma. Virus iso-lation rate for these patients was 51%. Twenty‐five percent of the virus isolated patients had developed asthma. When we compared patients with and without asthma we didn't find any difference for virus isolation and isolated virus types. There wasn't also any differ-ence between atopic and nonatopic asthma. Rhinovirus was mostly isolated in the patients with poor income.
Conclusion:
In conclusion we didn't found viral infections as a risk factor for asthma in wheezy children.0649
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Clinical and functional features of
patients with bronchial asthma
Bazarova SA
1; Alyavi AL
1; Dzhambekova GS
1; Ismailova EN
21
Republican Specialized Scientific‐Practical Medical Centre of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan;2Tashkent Pediatric
Medical Institute, Tashkent, Uzbekistan
Background:
Purpose: conduct a study on clinical and functional features of patients with bronchial asthma.Method:
195 patients with BA Steps 2 and 3, who have been using “on‐demand” short‐acting beta2‐agonists, and who did not take basic medical drugs in the last 3 months (glucocorticosteroids, long‐acting beta2 agonists), were examined. 95 patients (49%) were found to have BA Step 3, and the other 100 patients (51%) BA Step 2. The duration of disease amounted to 10.62 ± 0.43 years (3‐20 years). Asper results of the Asthma Control Test (ACT), the symptom control level recorded a score of 17.09 ± 0.14 (11‐20) on an average out of the maximum 25. Twenty healthy volunteers comprised the control group. Condition of the patients was assessed subjectively based on a five‐point scale (1‐5) and on the daily requirement for short‐acting B2‐agonists; whereas, objective assessment was conducted based on the figures of the external respiratory function (ERF) and diurnal vari-ation in peak expiratory flow rate (PEFR).
Results:
At the time of inclusion of patients in the study, the diur-nal variation in PEFR was 24.58 ± 0.19%, ERF figures (6 parameters) and accurately decreased when compared to CG (P< 0.001). Moder-ately severe obstruction was detected in 126 patients, moderate obstruction (FEV1 60‐63% of the due) in 45 patients, apparent obstruction (FEV1 47‐49% of the due) in 24 patients. Assessment of the condition of patients on the choking intensity in points also revealed an accurate difference between groups, with a high degree of choking among patients with asthma BA Step 3 (P< 0.001). Dynamics of bronchial obstruction was fairly higher among patients with BA Step 3 compared to patients with BA Step 2 (P< 0.001 for both figures). Velocity and volume figures of ERF in patients with BA Step 3 were lower compared to patients with BA Step 2 (P< 0.05, P < 0.001). The frequency distribution of patients in groups based on the obstruction levels revealed that patients with BA Step 3 of apparent obstruction fairly dominate the group com-pared to patients with BA Step 2 (P< 0.01).Conclusion:
The study showed that BA patients with an increased step of disease experience an increase in the dynamics of bronchial obstruction, which determined based on the diurnal variation in PEFR, a decrease in the velocity parameters of the ERF, and an increase in the choking intensity; the remaining subjective data does not depend on the step of disease.0651
|
Physician beliefs about asthma
diagnosis: Results of an electronic survey to
identify specialty
‐specific knowledge‐gaps versus
a transculturized evidence
‐based clinical
guideline recommendations
Larenas-Linnemann DE
1; Luna-Pech JA
2;
Rodriguez-Gonzalez M
3; Fernandez-Vega M
4; Del Rio-Navarro BE
5;
Cano-Salas MDC
4; Ortega-Martell JA
6; Romero-Lombard J
7;
Lopez-Estrada EDC
4; Salas-Hernandez J
41Hospital Médica Sur, Mexico City, Mexico;2Centro Universitario de
Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico;
3Instituto Nacional de Pediatria, Mexico City, Mexico;4Instituto
Nacional de Enfermedades Respiratorias, Mexico City, Mexico;5Hospital
Infantil de Mexico Federico Gomez, Mexico City, Mexico;6Universidad
Autónoma del Estado de Hidalgo, Pachuca, Mexico;7Hospital General,
ISSSTE, Saltillo, Mexico
Background:
Diagnostic strategies for asthma have been improved in past years favored by a better understanding of itsphysiopathology and the emergence of evidence‐based clinical guidelines. However, variation still exists among some diagnostic aspects of asthma in real life. It is unknown to what degree diagnosis is affected by the treating physician's medical specialty.
Method:
An online survey of general practitioners (GPs) and board‐ certified physicians of 4 medical specialities about their knowledge about diagnostic criteria, phenotyping and classification of asthma was performed. The replies were analyzed per specialty against the newly‐developed 2017 Mexican Asthma Guideline's (MAG) evidence‐ based recommendations. Response proportions were contrasted with chi square.Results:
A total of 62 GPs, 239 pediatricians, 364 allergists, 161 pulmonologists and 34 otolaryngologists (ORLs) replied. Although for general application of diagnostic clinical criteria all physicians rated similarly, in general accordance with the MAG suggestions, a third of non‐pulmonologist practitioners don't recognize chest discomfort as one of the clue symptoms of asthma, but they erroneously believe crackles are (P = 0.01). We found agreement in almost half of all physicians to erroneously believe that viral illness’ induced wheezing in non atopic children predisposes asthma. Conversely, 75‐85% are aware that allergic sensitization predisposes to asthma. Most special-ists‐except pulmonologists (P = 0.02)‐ incorrectly listed FEV1 as the best parameter to identify airflow obstruction (AO) and FEV1/FVC to assess AO severity. 20% of GPs do not know peak expiratory flow (PEF) measurements could be valuable, and 75% of all specialists are not aware that changes in PEF can also be used to confirm AO reversibility. To classify asthma, only pulmonologists adequately con-sidered the level of control in similar proportion than severity (81% and 83%, respectively), which is uniformly the preferred method by most other specialists.Conclusion:
Although in general many clinical aspects of asthma diagnosis seem to be accurately assessed, there is a wide speciality‐ specific variation regarding some aspects of phenotyping andclassification, diverging from MAG's recommendations. As such, our results can help to detect knowledge‐gaps and to guide the develop-ment of more focused specialty‐specific learning tools to improve clinical impressions, process medical evidence, and apply it to patient care.
0652
|
Issues, continuous medical education on
treatment of acute asthma, exercise induced
asthma and asthma in pregnancy should include,
per medical specialty
Larenas-Linnemann DE
1; Rodriguez-Tejada A
2;
Rodriguez M
2; Fernandez M
3; Luna-Pech JA
4; Cano-Salas C
5;
Ortega-Martell JA
6; Del Rio-Navarro BE
7;
Mayorga-Butron JL
8; Villaverde J
8; Romero-Lombard J
91Hospital Médica Sur, Mexicocity, Mexico;2Instituto Nacional de
Pediatría, Ciudad De México, Mexico;3Dean
's office, of the Instituto Nacional de Enfermedades Respiratorias“Ismael Cosio Villegas”, Ciudad De México, Mexico;4Universidad de Guadalajara, Centro Universitario
de Ciencias de la Salud, Guadalajara, Mexico;5Instituto Nacional de
Enfermedades Respiratorias“Ismael Cosio Villegas”, Mexicocity, Mexico;
6Department of pre and postgraduate medicine, Universidad Autónoma
de Hidalgo, Pachuca, Mexico;7Department of Allergy and Clinical
Immunology, Pediatric Hospital of Mexico“Federico Gómez”, Mexicocity, Mexico;8Instituto Nacional de Pediatría, Mexicocity, Mexico;9ISSSTE Hospital, Saltillo, Mexico
Background:
To unify and improve the management of asthma, including asthma exacerbations, the Mexican Guideline on Asthma (Guía Mexicana del Asma‐GUIMA 2017) was developed, as a tran-sculturization of the highest scoring internationally available asthma guidelines (BTS/SIGN, GEMA, GINA). Just prior to the GUIMA launch, knowledge of physicians was evaluated as part of the guide-line dissemination plan and to detect specialty‐specific knowledge% of correct answers (%) GUIMA R = recommends S = suggests Allergist (N = 364) Pulm (N = 161) Pediatr (N = 239) ENT (N = 34) GP (N = 62)
1. The first‐choice initial treatment of every mild‐ moderate, asthma exacerbation without complications is:
R: SALB MDI 2‐4 puffs or Nebulized SALB every 20 min (NOT:
SALB+Ipratropium Br) 66 45 49 80 46 43 78 53 50 50 50 36 71 53 42
2. The initial treatment of every patient with an asthmatic crisis includes systemic corticosteroids
S: yes 31 30 30 14 21
3. In a severe crisis salbutamol+ ipratropium bromide combined nebulization is more effective than solely salbutamol
S: yes 75 69 70 79 61
4. Recommendation of several add‐on medications for crisis
Of all correct add‐ons, % ticked: 8‐70 12‐80 12‐79 0‐57 5‐71
5. Can Dexamethasone IM or PO substitute prednisone?
R: yes 70 61 63 86 82
6. Exercise induced asthma can be treated with… R: Inhaled salb (or montelukast) 87 36 90 25 88 24 86 36 90 32
gaps that might lead to a more specialty‐directed teaching of GUIMA concepts.
Method:
An online questionnaire, Surveymonkey®was sent out to board‐certified members of National Societies of four specialties (al-lergists, pulmonologists, paediatricians, ENTs) and GPs. Results for treatment of acute asthma, exercise induced asthma and asthma in pregnancy are presented here and compared with GUIMA recom-mendations. Pearson's Xi‐square was used to detect differences between specialties.Results:
We had a total of 860 replies, see table 1. For severe acute asthma, allergists and ENTs knew less about magnesium sulphate than PED and PULM (P = 0.001). Less than 1/5 of allergists and ENTs knew about heliox. Theophylline is still mentioned by half of all physicians, though it is no longer recommended for acute asthma. Only a third knew budesonide is 1st choice ICS in pregnancy.Conclusion:
In general, several areas sensible for improvement could be detected, but with no clear specialty‐dependent difference. Continuous medical education in acute asthma should contain the following messages: (i) frequent inhaled SABA is the first line of treatment, leaving more expensive double‐bronchodilator treatment for severe cases; (ii) early introduction of systemic corticosteroids; (iii) theophylline does not form part of the treatment of acute asthma; (iv) there are several add‐on treatment options for severe asthma exacerbations (e.g. heliox, magnesium sulphate). For exercise induced asthma montelukast is a treatment option, and budesonide is the ICS of choice in pregnancy.0654
|
Smoking in adolescents in Latin
America
– A sad reality
Urrutia-Pereira M
1; Sanchez Aranda C
2; Polles P
2;
Badellino H
3; Acosta V
4; Medina Avalos M
5; Fernandez C
6;
Sisul-Alvariza JC
7; Castro-Almarales R
8; Gonzáles León M
8;
Nunes Rinelli P
1; Solé D
21Federal University of Pampa, Uruguaiana, Brazil;2Federal University of
São Paulo, São Paulo, Brazil;3UCES University, San Francisco
‐ Córdoba, Argentina;4Clinica del Pilares, Corrientes, Argentina;5Allergy Service of
the Hospital ISSSTE, Veracruz, Mexico;6Clínica INMUNE CDE, Ciudad
Del Este, Paraguay;7Clinica de Alergia y Asma, Asunción, Paraguay; 8
Policlinico Docente“Pedro Fonseca Alvarez”, Havana, Cuba
Background:
Smoking in Latino America (LA) is very common in adults. Despite the anti‐smoking prevention programs, many teens start smoking at school age. We evaluated the prevalence of smok-ing in adolescents livsmok-ing in LA.Method:
A prospective study conducted in adolescents (N = 5847; 12‐19 years; mean = 14.5 years), enrolled in municipal schools in 8 cities from 5 countries (Argentine, Brazil, Cuba, Mexico, Paraguay) in LA, who answered a self‐administered questionnaire on smoking (California Tobacco Survey*)Results:
Although 75.3% of adolescents in Latin America are told by their parents not to smoke, 39.5% have had tobaccoexperimentation (ever tried a cigarette, even one or two puffs), and 22.7% smoked at least once in the last month. 36.3% of those have had tobacco experimentation started smoking before 12 years of age.
Teens reported having ease in getting cigarettes (66.7%), although 92.6% believe that smoking at least one cigarette/ day is harmful to their health, 43.8% have a smoker friend and 27.3% would smoke a cigarette if it were given to them, 26.1% believe they are more respected because they smoke, and 30.7% believe that smokers have more friends, 49.4% have tried to quit smoking, 32.2% stated that they would smoke if there was a less toxic cigarette, 63.5% knew the electronic cigarette, 57.1% know about hookah. 45.0% are prohibited from smoking at home and 25.3% have no restriction on smoking at home.
Conclusion:
The prevalence of smoking among adolescents in LA is high. The implementation of measures to reduce/stop tobacco use and its new forms of consumption, such as electronic cigarettes and hookah in schools are urgent and imperative.0656
|
Role of community pharmacists in
educating patients with asthma
Pistja E; Themeli A
Medical Training Center Santa Maria, Lezhe, Albania
Background:
In asthma, the preventive measures taken by patients play an important role in improving life span and quality of life. This can be done more efficiently by community pharmacists by providing patient counseling and improving knowledge of patient about dis-ease, risk factors, medication management and preventive measures to control asthma.The objective of the study was to evaluate the contribution of com-munity pharmacists in improvement of life span and quality of life of asthma patients.
Method:
The study was performed from Mid September to Mid‐ December 2016 in the city of Lezhe, Albania. Data were collected by using a structured face to face questionnaire with randomly selected different community pharmacies. The questionnaire com-posed of different closed questions about the action plan of pharma-cists in asthma management and factors that affect the counseling of asthma patients by the pharmacists.Results:
It is noteworthy to observe that, in general, pharmacists are sufficiently knowledgeable and competent to counsel their asthma patients effectively.Conclusion:
The present study has revealed a number of salient points. Firstly, community pharmacists believe that, on the whole, their patients’ level of asthma management is optimal. In an attempt to improve this situation, there is a need to broaden pharmacists’ perceptions of their role in asthma management beyond counseling primarily on the medications dispensed. However, as time is a major factor influencing pharmacists’ ability to counsel, significant changesare needed within community pharmacy that will facilitate pharma-cists using their professional skills to become more actively involved in patient care and disease management and moving away from the traditional role of medication supply.
0659
|
Authorizations process analysis of an
immunotherapy prospective cost
‐effectiveness
study in asthma patients sensitized to mites: The
ITACA study (Late Breaking Abstract)
Meseguer-Arce J
1; Torres-Jaén M
2; Rodríguez-Lantarón M
3;
Martín-Lázaro J
4; Pujadas-Clar D
5; Iriarte-Sotés P
6;
Dalmau-Duch G
7; Moreno-Escobosa C
8; Fernández-Parra B
9;
De Luque-Pi
ñana V
10; Florido-López JF
11; Cardona-Dhal V
12;
Plaza-Martín A
13; Li
ñares-Mata T
14; Bartra-Tomás J
15;
Rico-Díaz M
16; Bernedo-Belar N
17; Marcos-Bravo C
18;
Ibero-Iborra M
19; Abellán-Alemán Á
20; Posadas-Miranda T
21;
Cancelliere N
22; Soler-López B
23; Delgado-Romero J
10;
González-De-Olano D
24; Tabar-Purroy AI
251Hospital Universitario Virgen de la Arrixaca, Murcia, Spain;2Hospital
Regional de Málaga, Málaga, Spain;3Complejo Hospitalario
Universitario de Huelva Juan Ramón Jiménez, Huelva, Spain;4Hospital
Lucus Augusti, Lugo, Spain;5Centro Médico Quirón Palmaplanas, Palma
De Mallorca, Spain;6Complejo Hospitalario Universitario de Ferrol, La Coruña, Spain;7Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain;8Hospital Torrecárdenas, Almería, Spain;9Hospital del Bierzo, León, Spain;10Hospital Universitario Virgen Macarena, Sevilla, Spain;11Complejo Hospitalario Universitario San Cecilio, Granada, Spain;12Hospital Universitari Vall d'Hebron, Barcelona, Spain;
13
Hospital Sant Joan de Déu, Barcelona, Spain;14Hospital Provincial de Pontevedra, Pontevedra, Spain;15Hospital Clínic i Provincial,
Barcelona, Spain;16Hospital Abente y Lago, La Coruña, Spain; 17Hospital Universitario Araba, Vitoria, Spain;18Hospital Meixoeiro,
Pontevedra, Spain;19Consorci Sanitari de Terrassa
‐ Hospital de Terrassa, Barcelona, Spain;20Hospital General Universitario Los Arcos
del Mar Menor, Murcia, Spain;21Hospital Vithas Xanit International,
Málaga, Spain;22MERCK, S.L.U., Madrid, Spain;23E
‐C‐BIO, S.L., Madrid, Spain;24Hospital Universitario Ramón y Cajal, Madrid, Spain;
25Complejo Hospitalario de Navarra/IdisNa, Pamplona, Spain
Background:
Few studies evaluate the cost‐effectiveness of immunotherapy for allergic disease, until now mainly based on phar-macoeconomic models and not on the analysis of data collected prospectively in real world setting. Immunotherapy is clinically effec-tive, but we must know if it is also from the economic perspective. To cover this need a study adjusted to“real life” was designed. The objective of this communication is to show a temporal metric of the authorizations management of the study and to evaluate the admin-istrative difficulties with which the post‐authorization studies of prospective follow‐up are found in Spain.Method:
This is an observational cost‐effectiveness study post‐ authorization of prospective follow‐up. Fifty centers with national representation were selected in 14 Autonomous Communities. Patients with confirmed diagnosis of asthma with or without rhinoconjunctivitis due to sensitization to mites with indication of treatment with specific immunotherapy would be included. Patients would be observed for six months before starting immunotherapy, and followed up to six years, with a total duration of follow‐up of six and a half years.Results:
Fifty eight percent of the selected centers (29) finally par-ticipated in the study. The mean time from the acceptance of the study by the researcher until the signing of the contract with the center was 130 days (IC 95% 95‐164). The mean time from the request for authorization to the Autonomous Communities to the approval of the study was 73 days (95% CI 39‐108). Two autono-mous communities did not authorize the study and as a consequence 11 centers (22%) were withdrawn from the study.Conclusion:
Pos authorization prospective studies face great administrative difficulties, in spite of their importance since they constitute a real reflection of the results of the effectiveness of the treatments. These difficulties should be solved by the health authori-ties in order to promote the knowledge of effectiveness in real life.SUNDAY, 27 MAY 2018 T P S 0 3
O C C U P A T I O N A L A L L E R G Y , A S T H M A A N D R H I N I T I S
0660
|
Evaluation of wheat flour sensitivity
and respiratory symptoms in a bread factory in
Ankara, Turkey
Aydin O; Celebi Sozener Z; Demirel Y; Secil D; Mungan D
Ankara University School of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Ankara, Turkey
Background:
Baker's asthma (BA) is one of the most common causes of occupational asthma. The prevalence in our country is reported as 5%. The main allergen causing BA is wheat flour. The aim of study was to determine respiratory symptoms and allergic sensitization to wheat flour in workers of a bread factory in Ankara.Method:
All steps of the study were carried out in the workplace by the research team who made regular visits to the bread factory. A survey was conducted to determine the presence of respiratory symptoms and its relation with the occupation. Skin prick tests with respiratory allergens (house dust mites, storage mites, grass pollen mix, aspergillus] and food allergens [wheat, rye, oats and barley flour, egg white, egg yolk) were performed. Pulmonary functions were measured by a portable spirometer.Results:
A total of 162 patients (F/ M: 3/159, mean age 38.25 ± 7.8 years) were included in the study. The mean working period was 11.23 ± 7.38 years. Eighty‐four workers (51.9%) were smokers. Family history of asthma was positive in 7 (4.3%) individu-als. There were 118 (71.7%) employees who had exposure to flour. Of the 99 workers (61.1%) who described symptoms, 88 (88.8%) had nasal, 57 (57.5%) had respiratory and 35 (35.3%) had eye symp-toms. In 71 (72.4%) employees, the symptoms began after starting work. The symptoms increased at workplace in 68 (69.4%) and decreased at off‐work period in 54 (55.1%) workers. Of the 68 employees who described increase in symptoms at workplace, 51 (68.4%) had an increase with flour exposure and 11 (16.1%) with flour plus additives. Prick skin tests were positive in 43 (26.5%) employees. Sensitivity to wheat flour was present in 23 (14.2%) sub-jects among all workers. Wheat flour sensitivity was positive in 19 (19.2%) of 99 employees with respiratory symptoms and in 13 (25.5%) of 51 employees who stated increased symptoms with flour exposure. Among all workers 9 (5.5%) employees were diagnosed as asthma and 7 (4.3%) workers were diagnosed as BA.Conclusion:
Wheat flour sensitivity is high among workers who are exposed to wheat flour, however the prevalence of BA is similar to the previous data in the literature.0661
|
Occupational allergy to
transglutaminase in a chef
—A case story
Johnsen CR
1; Callesen KT
2; Jensen BM
2; Poulsen LK
21Clinic of Allergy, Dept. of Dermato
‐Allergology, Gentofte Hospital, Copenhagen, Denmark;2Laboratory of Allergy, Gentofte Hospital,
Copenhagen, Denmark
Background:
Enzymes are well known as sensitizers and causes of occupational allergy primarily in the industries producing and using the products. We present a case of occupational contact urticaria, rhino‐conjunctivitis and asthma in a 32 year male chef who was using a transglutaminase enzyme powder obtained from fermenta-tion of streptomyces mobaraense as meat glue in processing of fine culinary dishes. This transglutaminase has been used for protein food preparation in industrial settings since 1992 to improve the texture of protein rich foods such as surimi or ham. In this case it was used in small scale in a gastronomy restaurant kitchen spraying enzyme powder with a sieve over raw meat without any protective equip-ment in contrast to the producer's recommendation. The chef was also found allergic to dried, edible mushrooms also forming part of the meat dish prepared with the transglutaminase enzyme powder. In one occasion he experienced an oral reaction with itching and swelling of the mucosa in the mouth, stridor, angioedema of the face, and urticaria after ingestion of beef meat treated with transglu-taminase and rolled in horn of plenty dried mushroom powder. No other symptoms of food allergy were reported but a known cat allergy was.Method:
Skin prick test, Histamine Release Test, Peak flow mea-surements and pulmonary function tests.Results:
Skin prick tests (SPT) were positive to saline solutions of two transglutaminase enzyme powders and mushroom powders of (horn of plenty (craterellus cornucopioides), porcini (boletus edulis), dotted stem bolete (boletes luridiformis), king trumpet (pleurotus eryn-gii) and cat. SPT were negative to meat from cow, pig, lamb, other mushrooms, common food allergens, pollens, dog, horse, house dust mites and moulds.SPT were negative to additive components of the transglutaminase enzyme powders (maltodextrin, miprodane and lactonate). SPT with the transglutaminase enzymes was negative in a control subject. Histamine Release Test with two transglutaminase enzyme powders and horn of plenty were highly positive in the patient.
Peak flow measurements during weekdays showed a 21% variation with reduced values at the end of workweeks. FeNO 27.9 ppb. Nor-mal FEV1 and FVC.
Conclusion:
We present to our knowledge the first case of enzyme allergy to transglutaminase used in molecular gastronomy.0662
|
Three case of work
‐related rhinitis in a
pathology unit
Folletti I; Paolocci G; Muzi G; Murgia N; Gambelunghe A;
Giuliani A; Dell
'Omo M
Department of Medicine, Section of Occupational Medicine, Respiratory Diseases, Occupational and Environmental Toxicology, University of Perugia, Perugia, Italy
Background:
Formaldehyde and xylene are occupational skin and respiratory irritant and/or sensitizer, exposure to those may be asso-ciated with dermatitis, rhinitis and asthma. Health care workers, as nurses, laboratory technicians, doctors could be exposed in different tasks in operating rooms, endoscopy and in pathology laboratory. We describe three cases of work‐related rhinitis in technicians employed in the same unit of hospital pathology .First case:
A woman of 38 years old underwent medical examina-tion in our occupaexamina-tional allergy unit because allergy respiratory symptoms. She has been working for 8 years in pathology laboratory and was exposed to xylene and formaldehyde. She developed rhini-tis, rhinosinusirhini-tis, hyposmia and cough with sputum after 5 years started work. She had negative skin prick test for common aeroaller-gens. Lung function was normal with a FEV1/FVC ratio of 80% of predict. Blood cells count reveled 15% of eosinophils (980/mmc) with 6550 total leucocytes.Second case:
A Woman of 40 years old was affected by moderate persistent allergic rhinitis with positive skin prick tests to house dust mite, dog and cat. In the last year rhinitis symptoms worsened in relation to work and improved during vacation. When she was exposed mostly to formaldehyde during shift at the end of it she usually experienced face skin and conjunctival erythema. She devel-oped work‐related symptoms after 14 years of exposure in the pathology unit.Third case:
A woman of 38 years old, who has been working for 14 years in the pathology unit and was exposed to formaldehyde and xylene, in the last year developed moderate‐severe persistent rhinitis with hyposmia and chronic cough. She referred to otorhino-laryngologist and an irritant induced rhinitis was diagnosed. She had negative skin prick test for common allergens and normal lung func-tion.Results and conclusion:
The workers experienced respiratory symptoms in relation to work exposure to formaldehyde and xylene. The suspected causal agents were monitored in the work environ-ment and an exceeding of the recommended limit values was found. Preventive measure were adopted with a reduction of exposure and symptoms improve only in the second and third case.0663
|
The usefulness of the mannitol
challenge test for occupational asthma in
bakers
—preliminary results
Walusiak-Skorupa J; Nowakowska-Swirta E;
Marcinkiewicz A; Lipinska-Ojrzanowska A; Wiszniewska M
Nofer Institute of Occupational Medicine, Lodz, Poland
Background:
Diagnosis of occupational asthma (OA) requires methods of high specificity and sensitivity to exclude false positive and false negative results. The specific inhalation challenge test (SICT) remains the reference method for the diagnosis of OA. Moni-toring of SICT comprises evaluation nonspecific bronchial respon-siveness (NSBHR) measured at baseline and after SICT. Inhalant challenge test with mannitol is considered to be more specific than test with methacholine. Also, duration of procedure is shorter and safer. Therefore the study aim was to compare the usefulness of these two tests in monitoring of SICT.Method:
Four bakery workers with suspicion of OA underwent sin-gle‐blind, placebo‐controlled SICT with workplace allergens accompa-nied by evaluation of NSBHR with mannitol and methacholine before and after SICT. Clinical examination, spirometry, skin prick tests (SPTs) to common aeroallergens and occupational allergens, serum specific IgE antibodies to occupational aeroallergens were also performed.Results:
Positive SPTs results to occupational aeroallergens were found in all bakery workers, specific IgE to flours were detected only in two subjects.Three out of the four patients displayed positive SICT reaction (in two cases early spirometric response). In all of these 3 patients, air-way response to methacholine increased significantly. In the first two patients also airway reaction to mannitol was significant, whereas in one subject with early reaction there was no increase in NSBR after mannitol inhalation. The patient with negative SICT results did not reveal any changes in NSBR before and after the test, neither to methacholine nor mannitol.
Conclusion:
Preliminary results indicate the need of further investi-gations to evaluate the usefulness of mannitol challenge test in the diagnostics of occupational asthma.0664
|
Occupational rhinoconjunctivitis and
asthma caused by allergy to buckwheat flour
Bernaola M
1; Camino ME
2; Bernaola G
2; Vera A
1; Bartha I
1;
Jimeno L
3; Urrutia I
4; Pascual S
4; Dorado S
41
Department of Allergy, Hospital Universitario La Princesa, Madrid, Spain;2Department of Allergy, Hospital de Galdácano, Vizcaya, Spain;
3
Department of I+D ALK, Madrid, Spain;4Department of Pneumology, Hospital de Galdácano, Vizcaya, Spain
Background:
Buckwheat (Fagopyrum esculentum) is a herbaceous plant of the Polygonaceae family, originated from Central Asia. Thereis an increasing use of buckwheat flour since it is marketed as a healthy, gluten‐free substitute for patients with celiac disease and is also used in “organic or ecological” food. IgE‐mediated allergy to buckwheat by inhalation and ingestion of its flour has been described previously.
Method:
A 45‐year‐old male baker with a history of mild allergic rhinitis to mites presented with 8 months of coughing, wheezing, dyspnea, sneezing, rhinorrhea and ocular pruritus when his co‐ worker kneaded buckwheat flour. Symptoms disappeared when he performed his usual work, kneading wheat flour and rye, and when he was at home.A skin prick‐test with aeroallergens and food (including flours) was performed. Testing included a prick‐prick test with buckwheat flour and a prick test with an extract of this flour at 5% w/v prepared by ALK‐Abelló. Further workup included specific IgEs to flours (Immu-noCAP™), immunoblotting, methacholine challenge test and specific bronchial challenge (SBC) with buckwheat flour by exposure in a challenge chamber.
Results:
Skin tests were positive for dust mites and buckwheat flour extracts. Total IgE was 187 KU/L with specific IgE to Der-matophagoides pteronyssinus, Lepidoglyphus destructor, buckwheat, and cereal flours of 10.1, 1.98, 15.4 and <0.1 KU/L respectively. Immunoblotting detected several IgE‐binding bands against different proteins of buckwheat extract (9‐75 KDa). Methacholine test was positive. After 4 minutes of exposure to buckwheat (SBC), he developed rhinoconjunctivitis with a 30% reduction in his FEV1.Conclusion:
We present a case of occupational rhinoconjunctivitis and asthma from IgE‐mediated allergy to buckwheat flour in a baker. Due to the increased consumption of“organic” and gluten‐free food, we will likely see a higher prevalence of allergy to this flour.0665
|
Two cases of occupational fish allergy
caused by percutaneous sensitization
Yamaide A
1; Yamamoto T
1; Tomiita M
1; Shimojo N
2;
Hoshioka A
11Department of Allergy and Rheumatology, Chiba Children
's Hospital, Chiba, Japan;2Department of Pediatrics, Graduate School of Medicine,
Chiba University, Chiba, Japan
Background:
Occupational hand eczema is a common health prob-lem in food handlers and cooks. Recently, it has been recognized the importance of percutaneous allergen sensitization through damaged skin. Direct exposure to food allergens through damaged skin could lead to develop food allergies among food handlers and cooks with hand eczema. It has not been well‐documented whether percuta-neous exposure to food allergens through damaged skin is a signifi-cant risk factor for the development of food allergy in adults or not.Case:
Two 26‐year‐old women (case 1 and case 2) with hand eczema visited our department because of fish allergy and eczema.They are dietician of our hospital, and daily handled raw fish for cooking without groves. Case 2 had atopic dermatitis. They had no history of food allergy before being employed. Their hand eczema appeared after starting their work, and they subsequently started to experience food allergy symptoms such as intraoral itchiness or dys-pnea after ingestion of raw or cooked fish. During cooking of fish, they presented urticaria, eyelid swelling, dyspnea, and cough. The specific IgE antibodies were detected for many fishes in both cases. They need to avoid fish at this time.
Conclusion:
Hand eczema is a risk factor for occupational food allergy, so we should recommend food handlers to avoid direct con-tact exposure to fish. The treatment of eczema and use of gloves while handling fish, which contribute to avoid percutaneous sensiti-zation to fish allergens, are important to prevent fish allergy. More attention should be paid to the risk of occupational food allergy by percutaneous sensitization.0666
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Allergic reaction to calving: A
‐galactose
as a new occupational allergen
Corriger J
1; Penven E
2; Lang M
1; Haumonte Q
1; Thomas H
1;
Nguyen-Grosjean VM
1; Pontier J
1; Vaillant A
1; Beaudouin E
11
Allergy Department, Hospital Emile Durkheim, Epinal, France;
2Occupational Diseases Department, University Hospital, Vandoeuvre
‐ Lès‐Nancy, France
