Occupational asthma caused by eastern white cedar ( Thuja occidentalis) with demonstration that plicatic acid is present in this wood dust and is the causal agent

Abstract

A worker developed symptoms of work-related asthma a few weeks after starting to work in a sawmill where eastern white cedar ( Thuja occidentalis) was transformed into shingles. The diagnosis of occupational asthma was confirmed by (1) monitoring of peak expiratory flow rates and bronchial responsiveness to histamine off work and at work, and (2) specific inhalation challenges in the laboratory that demonstrated an isolated late asthmatic reaction after exposure for 4 hours to the wood dust. Specific inhalation challenges with western red cedar ( Thuja plicata) for 2 hours and plicatic acid (PA) for 7 minutes also caused an isolated late asthmatic reaction. Elevated specific IgE levels to PA were present. Antiserum was produced in rabbits that were immunized with PA conjugated to human serum albumin. With this antiserum in inhibition experiments, cross-reactivity between western red cedar and eastern white cedar, both belonging to the family of arborvitae, was found. It is estimated that eastern white cedar contains approximately half the amount of PA present in western red cedar.