Abstract
BackgroundArgan is now used worldwide in numerous cosmetic products. Nine workers from a cosmetic factory were examined in our occupational medicine department, following the diagnosis of a case of hypersensitivity pneumonitis (HP) related to handling of argan cakes.MethodsOperators were exposed to three forms of argan (crude granulates, powder or liquid) depending on the step of the process. All workers systematically completed standardized questionnaires on occupational and medical history, followed by medical investigations, comprising, in particular, physical examination and chest X-rays, total IgE and a systematic screening for specific serum antibodies directed against the usual microbial agents of domestic and farmer’s HP and antigens derived from microbiological culture and extracts of various argan products. Subjects with episodes of flu-like syndrome several hours after handling argan cakes, were submitted to a one-hour challenge to argan cakes followed by physical examination, determination of Carbon Monoxide Diffusing Capacity (DLCO) and chest CT-scan on day 2, and, when necessary, bronchoalveolar lavage on day 4.ResultsSix of the nine workers experienced flu-like symptoms within 8 hours after argan handling. After challenge, two subjects presented a significant decrease of DLCO and alveolitis with mild lymphocytosis, and one presented ground glass opacities. These two patients and another patient presented significant arcs to both granulates and non-sterile powder. No reactivity was observed to sterile argan finished product, antigens derived from argan cultures (various species of Bacillus) and Streptomyces marokkonensis (reported in the literature to contaminate argan roots).ConclusionsWe report the first evidence of hypersensitivity pneumonitis related to argan powder in two patients. This implies preventive measures to reduce their exposure and clinical survey to diagnose early symptoms. As exposure routes are different and antibodies were observed against argan powder and not the sterile form, consumers using argan-based cosmetics should not be concerned.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-015-0013-3) contains supplementary material, which is available to authorized users.
Highlights
Argan is used worldwide in numerous cosmetic products
Argan oil is obtained according to an ancestral technique by heating, roasting and pressing the nuts contained in the fruit of Argania
On Day four (D4), bronchoalveolar lavage (BAL) was proposed only in subjects with flu-like symptoms during the hours following argan exposure and association of significant features on either High-resolution computed tomography (HRCT) scan or pulmonary function tests
Summary
Nine workers from a cosmetic factory were examined in our occupational medicine department, following the diagnosis of a case of hypersensitivity pneumonitis (HP) related to handling of argan cakes. Paris et al BMC Pulmonary Medicine (2015) 15:18 He reported brief episodes of flu-like syndrome (asthenia, myalgia, shivering, chest tightness) several hours after handling of crude argan powder derived from argan cakes. With his written and informed consent, the patient underwent a specific challenge to argan cake milling products at his workplace for one hour (D0), under medical supervision. This challenge was followed, eight hours later, by flu-like syndrome. The diagnosis of Hypersensitivity Pneumonitis (HP) was established in this patient according to form 1 of the HP study classification [4]
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