Occupational rhinoconjunctivitis due to hops exposure in a brewery worker

Abstract

Rationale Asthma and urticaria from beer has been reported in atopic patients. Barley, the basic ingredient used in brewing, has nearly always been the main allergen. Hops (Humulus lupulus) is known to cause allergy contact dermatitis but it has been rarely implicated in beer allergy. We try to prove the clinical relevance of hops as a occupational allergen in a brewery worker. Methods Case Report: An atopic 35-year-old brewery worker man, with rhinoconjunctivitis diagnosis due to grass and olea pollen, developed occupational rhinoconjunctivitis after three years of exposure to hops, staying symptom free away from his laboral environment. He was able to drink beer. We preformed skin-prick test with a common commercial inhalants battery including pollens, mites, animal dander, molds and latex. We also used hops and barley home-made extracts. Specific IgE to barley, malt, corn, wheat and hops were also carried out. In order to demonstrate the patients symptoms we made a nasal challenge with hops extract. Results Skin-prick test were positive to grass, olive pollen and also with hops. Specific IgE was positive only to hops. Nasal challenge with hops extract reproduced an immediate nasal response. Prick test with hops in 10 controls patients were negative. Conclusions We report a case of rhinoconjunctivitis after occupational exposure to hops in a brewery worker, confirmed by a positive nasal challenge. The positive results of skin-prick test and specific IgE demonstrate an IgE mediated mechanism.