Occupational asthma due to tampico fiber bystander exposure in a brush production company—case report and literature review

Abstract

A female machine operator in a brush factory presented for an expert medical examination due to suspected occupational obstructive pulmonary disease. She reported the occurrence of severe respiratory distress whenever colleagues in the same working area processed tampico fibers or a mixture of tampico fibers and bassine. The challenge posed in terms of the expert appraisal was to either prove or rule out occupational causality and IgE-mediated (IgE, immunglobulin E) sensitization in relation to the reported workplace-related symptoms. As part of the further diagnostic work-up, tampico fibers were isolated from the workplace and the proteins biotinylated and coupled to a streptavidin ImmunoCAP for specific IgE testing. The material taken from the workplace was checked for mite allergen contamination. In addition, a systematic literature search was conducted in PubMed on “agave-/tampico fibers and diseases.” Tampico-specific IgE antibodies (10.5 kU/l and immunoblot labeling of protein bands in the 25-kDa range) were detected in the patient’s serum. The inhibition assay showed that mite-allergen contamination of the tampico materials was not responsible for the IgE reactivity. Tampico fibers are robust fibers obtained from the leaves of the Mexican Agave lechugilla. The literature describes several cases of skin reactions in the form of irritant contact dermatitis due to occupational exposure to agave leaves or contact with agave sap. In the present case, the asthma symptoms of a female worker in a brush factory were attributed to inhalant bystander exposure to tampico fibers in the workplace. The unequivocal evidence of sensitization to tampico fibers met the medical requirements for the recognition of an occupational disease (BK 4301).