Specific Challenge Test Research Articles

Evaluation of dietary yeast derived mannan oligosaccharide for pacific whiteleg shrimp Penaeus vannamei: Effects on growth performance, immune response, hepatopancreas morphology and resilience to infection against Vibrio parahaemolyticus

With trends towards low fishmeal and higher plant ingredient-based diets for shrimp, there is consequently greater demand on feed additives to bolster the protein and nutrient profile quality for achieving more efficiency. Also, there is a need to enhance innate immunity and resilience to infection under intensive shrimp production scenarios. This investigation tested incremental levels 0, 0.2; 0.4; 0.6 and 0.8 % of a commercial yeast cell wall extract mainly comprising β-glucan and mannan oligosaccharides (MOS) (YM, YeaMOS, Angel Yeast, Yichang, Hubei, China) for post-larval shrimp Penaeus vannamei in isonitrogenous and iso-lipidic diets with proteinaceous plant ingredients amounting to 50 % contribution of the diet formulation. After 60 d, growth and feed utilization performance were not significantly affected in shrimp in terms of weight gain or FCR, but due to much higher survival, total biomass in groups of shrimps fed with dietary YM was higher compared to the control treatment. A sequential specific pathogen challenge test with Vibrio parahaemolyticus at final dose of 104 CFU mL−1 resulted in a marked improvement in survival against the control group with much enhancement at the inclusion level of 0.4 % YM (p<0.05). Before challenged, the total haemocyte count (THC) and the relative gene expression of Prophenoloxidase (ProPO) were higher in the group of shrimps fed with YM. Likewise, after infection, the amount of THC and ProPO remained better in the group of shrimps fed with YM. However, the 0.8 % YM treatment did not significantly differ from the control for phagocytic activity and index. The histomorphology condition of the hepatopancreas of shrimp before the infection for all treatments appears normal without significant numbers of hepatopancreatic tubules (T) and epithelial cell vacuoles (V). After pathogen challenge, all shrimp exhibited severe necrotic cell damage and massive sloughing of hepatopancreatic tubule epithelial cells into the lumen. Overall, giving YM as feed additives can improve the shrimp biomass and health, with the use of 0.4 % inclusion levels in practical diets for shrimp P. vannamei become the optimum dose to develop more efficient aquafeed production.

Paternal-effect-genes revealed through sperm cryopreservation in Perca fluviatilis

Knowledge about paternal-effect-genes (PEGs) (genes whose expression in the progeny is influenced by paternal factors present in the sperm) in fish is very limited. To explore this issue, we used milt cryopreservation as a specific challenge test for sperm cells, thus enabling selection amidst cryo-sensitivity. We created two groups of Eurasian perch (Perca fluviatilis) as a model – eggs fertilized either with fresh (Fresh group) or cryopreserved (Cryo group) milt from the same male followed by phenotypic-transcriptomic examination of consequences of cryopreservation in obtained progeny (at larval stages). Most of the phenotypical observations were similar in both groups, except the final weight which was higher in the Cryo group. Milt cryopreservation appeared to act as a "positive selection" factor, upregulating most PEGs in the Cryo group. Transcriptomic profile of freshly hatched larvae sourced genes involved in the development of visual perception and we identified them as PEGs. Consequently, larvae from the Cryo group exhibited enhanced eyesight, potentially contributing to more efficient foraging and weight gain compared to the Fresh group. This study unveils, for the first time, the significant influence of the paternal genome on the development of the visual system in fish, highlighting pde6g, opn1lw1, and rbp4l as novel PEGs.

Over restrictive elimination of foods in children with food allergy.

Previous studies demonstrated critical deficits in diagnosis and management of childhood food allergy (FA), and recent developments in FA research support adopting a proactive approach in FA management. Our objective was to describe FA knowledge and management patterns of pediatricians. We applied a 24-item survey to 170 general pediatricians, pediatric allergists and pediatric gastroenterologists practicing in Turkey. Some IgE-mediated symptoms of FA such as cough, urticaria, wheezing and anaphylaxis were falsely recognized as symptoms of non-IgE-mediated FA by 30%, 29%, 25% and 19% of the participants, respectively. By contrast, 50% of the participants falsely recognized bloody stool, a finding of IgE-mediated FA. Most frequently and least frequently used diagnostic tools were specific IgE (30.5%) and oral food challenge test (1.7%), respectively. Maternal diet restrictions and infant diet restrictions were advised by 82% and 82%, respectively. Percentages of physicians eliminating only 1 food were 21%, 19%; 2 foods were 15%, 11%; 3 foods were 7%, 8%; 4-5 foods were 8%, 11%; 5 to 10 foods were 21%, 26%; and > 10 foods were 28%, 25% from the maternal and infant diet, respectively. Cow`s milk, cheese, butter, yoghurt, baked milk products and hen`s egg were the most commonly restricted items. Overall, FA knowledge of pediatricians was fair. Pediatricians utilize an overly restrictive approach when advising diet eliminations in FA. Recent developments favor a more proactive approach to induce immune tolerance and need to be encouraged in pediatric clinical practice. Future educational efforts should focus on emphasizing the deleterious effects of injudicious and extensive eliminations.

Allergen-specific IgE to recombinant latex allergens in occupational allergy diagnostics.

ObjectivesSpecific challenge tests (SICs) are considered reference tests for allergic occupational diseases diagnosis. However, in numerous cases, SICs cannot be carried out in the diagnosis of allergy to latex due to the risk of generalized reactions. The aim of the study was to evaluate the usefulness of sIgE determination to recombinant latex allergens in diagnostics of occupational respiratory allergy.Materials and MethodsThe study group comprised 44 healthcare workers (HCW) suspected of suffering from occupational respiratory allergy to latex (they underwent a physical examination, skin‐prick tests (SPTs) to common and latex allergens, spirometry and SIC) and 17 controls not occupationally exposed to latex, with a positive sIgE against latex. Each serum was tested for allergen‐specific IgE to aeroallergens, latex, eight recombinant latex allergens and CCD‐markers.ResultsSpecific IgE against Hev b5, 6.01, and 6.02 were significantly more frequently detected in HCWs and their mean serum levels were higher compared with the control group. In 26 HCWs with occupational asthma (OA), sensitization to Hev b5, Hev b6.01, Hev b6.02 was significantly more frequent than in 18 HCWs with work‐exacerbated asthma (WEA); they had positive results SPT to latex significantly more frequently in comparison with subjects with WEA.ConclusionsTest for recombinant latex allergens is much more accurate in recognition of latex allergy than test for latex extract, which seems to produce false‐positive results in patients with pollen allergy. The measurements of sIgE against recombinant latex allergens Hev b 6.01, 6.02, 5, and 8 are useful in differentiating OA from WEA.

Prevalence of Exercise Induced Bronchoconstriction in Recreational Adult Hockey Players as determined by Sport Specific Field Exercise Challenge Test

BACKGROUND: Exercise induced bronchoconstriction (EIB) is provoked by exercise and results in narrowing of the airways. Studies have shown an EIB prevalence of 11-50% in athletic populations. The diagnosis of EIB is dependent upon objective measurement of respiratory function, as respiratory symptoms are unreliable. Cold and dry ambient conditions contribute to the severity of EIB. The environmental conditions and manner of exertion an athlete is exposed to in ice hockey are significantly different than any current standardized laboratory test to evaluate for EIB. In a prior study of elite women hockey players, 39.5% presented symptoms of asthma and 21% demonstrated EIB. Sport-specific field exercise challenge tests (SSFECT) have been validated for the assessment of EIB, and are more sensitive than laboratory challenges in elite winter athletes. PURPOSE: To use a SSFECT to determine the prevalence of EIB in adult recreational ice hockey players, and the correlation between reported symptoms and diagnosis by this method. METHODS: Participants were 18 males and 2 females (mean age of 34.7 yrs, mean height of 1.78 m); who participated in 1 of 2 recreational ice hockey leagues in Chicago, IL. Using a Piko-1 portable spirometer, FEV1 was measured prior to the hockey game and immediately following periods 1, 2, and 3. All respiratory measurements occurred with hockey equipment adorned. Airway response was expressed as the percent fall in FEV1 from the baseline value. Diagnosis of EIB was given if athletes had a greater than 10% decrease in FEV1 from baseline measured at any time point. Athletes also completed an intake questionnaire prior to testing which included clinical symptoms, exercise history, and past medical history. RESULTS: EIB was diagnosed in 3/20(15%) athletes. A prior diagnosis of asthma or exercise induced asthma was reported in 5/20 (25%) athletes, yet only one of these had a decrease of > 10 % of FEV1 as measured by this test. Of the three EIB+, two were symptomatic (67%); and of the EIB-, 9/17 (53%) reported respiratory symptoms. Diagnosis of EIB was consistent for all three periods in all but one athlete. Mean FEV1 for the three periods was 4.08, 4.07, and 4.07 respectively. CONCLUSIONS: Symptoms remain unreliable for diagnosis of EIB. SSFECT can be utilized for diagnosis of EIB in ice hockey athletes.

Occupational respiratory allergy in peach crop workers.

Occupational respiratory diseases in workers of peach tree crops have been reported punctually and have been associated with sensitization to proteins present in both pollen and leaf tree. We report the study of 37 workers with respiratory symptoms related to occupational exposure to peach trees. Prick tests and specific IgE determinations were performed with extracts from leaves and branches of peach tree. Immunodetection in leaf extract was realized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis SDS-PAGE-immunoblotting with patient sera and rabbit serum anti-Pru p 3. Immunodetection inhibition was performed with rPru p 3 and pollen profilins. The clinical relevance of sensitization was demonstrated by specific bronchial challenge test (SBCT) with peach leaf extract. Most patients suffered symptoms when peach trees had leaves, specifically during thinning and harvesting fruit (rhinoconjunctivitis: 100% and asthma: 67.5%). Sensitization to leaf extract was demonstrated in 86% of patients. IgE-immunoblotting with peach leaf extract revealed in six patient sera a pair of bands of 10 and 16 kDa, and in nine a 16-kDa band. Those bands could be two isoforms of peach leaf lipid transfer proteins( LTP), so the recognition frequency of some LTP isoform by our patient sera was 42%. 33% of the sera recognized a doubled band of about 14.5 kDa and this recognition was inhibited by nPho d 2. The SBCT with peach leaf extract was positive in the asthmatic sensitized patients tested. Sensitization to peach leaves was the cause of occupational respiratory symptoms in our patients. Some patient sera revealed IgE-binding proteins matching LTP and/or profilin.

Determination of albumin adducts of 4,4′-methylenediphenyl diisocyanate after specific inhalative challenge tests in workers

4,4′–Methylenediphenyl diisocyanate (MDI) is the most important isocyanate used in the industry. Lung sensitization with bronchial asthma is the main disorder in exposed workers. Albumin adducts of MDI might be involved in specific immunological reactions. MDI adducts with lysine (MDI-Lys) of albumin have been found in MDI-workers and construction workers. MDI-Lys is an isocyanate-specific adduct of MDI with albumin. In the present study, we report MDI-adducts in workers undergoing diagnostic MDI challenge tests. The workers were exposed for 2h to 5ppb of MDI. The adduct levels increase significantly after the exposure to MDI in the challenge chamber. About 0.6% of the dose was bound to albumin. So far, only urinary metabolites of MDI were measured to monitor isocyanate workers. However, such urinary metabolites are not isocyanate specific. Therefore, we propose to measure albumin adducts for monitoring MDI exposed subjects.

Changes in PH in exhaled breath condensate after specific bronchial challenge test in patients with chronic hypersensitivity pneumonitis: a prospective study.

BackgroundThe aim of this study was to investigate the influence of the specific inhalation challenge (SIC) on changes of pH values in exhaled breath condensate (EBC) in patients with hypersensitivity pneumonitis (HP).MethodsA prospective study of 85 patients with suspected HP, of whom 63 were diagnosed with HP due to exposure to avian or fungal antigens. In all cases, EBC samples were collected before and after completion of the SIC and pH values were determined.ResultsTaken as a whole, patients with HP did not present changes in EBC pH after SIC. However, considering only patients with exposure to molds, those diagnosed with HP had a significantly more acid pH post-SIC than those with another diagnosis (p = 0.011). This fact is not observed in patients exposed to bird’s antigens. A ROC curve showed that a reduction in EBC pH of 0.3 units or more after SIC in patients diagnosed with HP due to exposure to molds had a sensitivity of 30 % (CI: 12.8 to 54.3 %) and a specificity of 100 % (CI: 65.5 to 100 %).ConclusionEBC pH may be useful in interpreting SIC results in patients with HP, especially in those patients exposed to molds. Further studies are now required to test the validity of these proposals.

Zastosowanie alergenów rekombinowanych w diagnostyce zawodowej alergii na lateks

Over many years, allergy to natural rubber latex has been a major problem among health care workers (HCW). The diagnosis of occupational allergy requires methods of high diagnostic accuracy in view of certification implications (e.g., a sick worker quits a job). With the development of molecular methods, the frequency of application of recombinant allergens it the diagnostics of allergic diseases continues to increase. This paper reviews the applicability of laboratory tests which use recombinant allergens in the diagnostics of occupational allergy. The diagnosis of latex allergy is based on the presence of clinical symptoms linked with exposure to latex allergens, positive skin prick tests and detection of specific IgE antibodies to latex in serun. Moreover, in some cases specific challenge tests are conducted. The analysis of literature indicates that applying the panel of recombinant latex allergens in diagnostic tests, cross-reactivity can very likely be excluded and/or sensitization can be confirmed without the need for specific challenge tests, which in case of latex allergens carries a potential risk of aeneralized reactions.

Indian Lettuce Extract as Feed Additive Enhances Immunological Parameters in Mono-Sex Nile Tilapia against Aeromonas hydrophila

Aims: The present study evaluated the efficacy of dietary doses of Lactuca indica extract on immunological parameters and disease resistance against Aeromonas hydrophila infection in mono-sex Nile tilapia, Oreochromis niloticus. Place and Duration: This experiment was performed in the Laboratory of Fisheries and Marine Bioscience (FMB), Jessore University of Science and Technology (JUST), on July to December 2013. Methodology: Lactuca indica extract preparations, harbal diet preparations, Aeromonas hydrophila Isolation, specific and non-specific immunological assays (following phagocytic activity and serum agglutination) and challenge test were performed. Result: A. hydrophila is a more drastic disease producing and common cause of bacterial haemorrhagic septicaemia, it is a gram-negative, non spore-forming, rod-shaped, yellowish colony forming bacteria. Fishes were fed with L. indica extract at 0%, 0.5%, 1%, 1.5% and 2.0%; among those 2.0% showed highest significant responses in phagocytic activity, specific growth rate, specific and non-specific immune responses on week 2 and 4 compared to control diet whereas the changes did not manifest on first week. All groups fishes were injected intraperiotonaly (i.p.) with A. hydrophila at 3.5×10-7 CFU ml-1 for analyzing cumulative mortality on 30th day of feeding. L. indica enriched diet at 2.0% level resulted in lowest mortality (20%) indicating highest protection (Relative Percent Survival, RPS 75%) from A. hydrophila infection than 0.5%, 1.0% and 1.5% doses diet that resulted 72%, 56% and 32% mortalities respectively. 2% dose also showed highest growth compare to other doses. Conclusion: The results suggest that the dietary supplementation of L. indica extract stimulates immunostimulants, reduce mortality and increases disease resistance in O. niloticus against A. hydrophila infection.

Asthma caused by potassium aluminium tetrafluoride: a case series.

The objective of this study is to describe a case-series of potassium aluminium tetrafluoride (KAlF4)-induced occupational asthma (OA) and/or occupational rhinitis (OR). The study involves five patients from a heat-exchanger production line who were examined (including specific inhalation challenge tests) for suspected OA and/or OR caused by a flux containing almost 100% KAlF4 − with fluorides’ workplace air concentrations ranging between 1.7 and 2.8 mg/m3. No subject had a previous history of asthma. All five patients had a positive specific challenge test (three patients were diagnosed with OA alone, one with OR and one with both OR and OA). At the follow-up visit, after three years on average, all patients needed permanent corticosteroid therapy (four topical, one oral). After elimination from the exposure, only one of the observed subjects gave an indication of an improvement, two subjects stabilized and two worsened. Our case series focuses on the correlation between patients’ exposure to fluorides in air-conditioner production and the subsequent occurrence of OR/OA. Currently, it is uncertain whether these OR/OA were caused by hypersensitivity or irritation.

A novel and well tolerated mite allergoid subcutaneous immunotherapy: evidence of clinical and immunologic efficacy.

Allergy to house dust mite is one of the most common causes of allergic rhinitis. A novel tyrosine-adsorbed, modified allergen product, Acarovac Plus, developed for the treatment of perennial mite allergy seeks to address the underlying cause of allergic rhinitis in this instance. One of two dosing regimens may be used, either the Conventional Regimen or the Cluster Regimen. We sought to compare the efficacy and safety of a specific immunotherapy, developed for the treatment of perennial mite allergy, administered under a Conventional and Clustered dosing schedule in patients with persistent allergic rhinitis. Thirty adult patients, between 18 and 65 years old, with allergic rhinitis and/or asthma secondary to hypersensitivity to Dermatophagoides pteronyssinus were administered with either conventional or cluster initial regime, with a final visit one week after the last dose administration. The efficacy to the Conventional and Cluster regimens was measured using a Nasal Challenge Test monitoring clinical symptoms and peak nasal inspiratory flow. Total IgE, serum-specific inmunoglobulins (IgE and IgG4) to Dermatophagoides pteronyssinus and relevant cytokines (IFN-γ, IL-4, IL-5, IL-10 and IL-13) were assessed. A Satisfaction Questionnaire (TSQM) was completed after each patient's final visit. The tolerability of the vaccine was assessed monitoring adverse reactions. No adverse events were recorded in either conventional or cluster regime. The specific Nasal Challenge Test led to a decrease in symptom scores and a significant decrease in mean nasal peak inspiratory flow drop was recorded in both dosing regimen groups. A significant increase in IgG4-specific antibody titres was assessed. No significant changes were observed in concentrations of total IgE, specific IgE or cytokines (IFN-γ, IL-4, IL-5, IL-10 and IL-13). Patients declared themselves most satisfied in relation to “Secondary effects”, with high overall satisfaction in both groups. Cluster and conventional specific immunotherapy resulted in no adverse reaction(s) and led to similar improvements in immunological parameters, clinical efficacy (Nasal Challenge Test) and high overall satisfaction.

Diagnosis and allergen immunotherapy treatment of polysensitised patients with respiratory allergy in Spain: an Allergists' Consensus.

BackgroundPolysensitisation is common in patients with respiratory allergy in Spain. Selection of the best allergen immunotherapy (AIT) is difficult in polysensitised patients. The present study was designed to help allergists better identify relevant allergens in these patients and to improve the selection of AIT in Spain.MethodsSixty-two Spanish allergists answered a survey containing 88 items divided into four groups: 1) general approach to polysensitised subjects; 2) sensitisation profile involving mite, animal dander and moulds; 3) grass and olive pollen co-sensitisation, and 4) other pollen polysensitisation profile (weed and tree pollen). The Delphi method was used.ResultsA consensus was achieved for 83% of items (92%, 81%, 83% and 73% of the four groups analysed, respectively). Only polysensitised patients with clinical relevance should be considered polyallergic. A detailed medical history (clinical symptoms and medication) together with a profound knowledge of allergens present in the patient’s environment are essential for diagnosis. Skin prick tests (SPTs) are not adequate to decide the clinical relevance of each allergen. Serum specific IgE against allergen sources adds value to SPT but molecular diagnosis, when possible, is strongly recommended, especially in pollen-allergic patients. Specific allergen challenge tests are difficult to perform and not recommended for daily practice. Regarding AIT composition, up to three allergens can be used in the same vaccine, but only related allergens may be mixed. In some cases more than one vaccine may be needed.ConclusionSome criteria have been established to improve diagnosis and AIT prescription in polysensitised patients.

Fractional Exhaled Nitric Oxide in the Interpretation of Specific Inhalational Challenge Tests for Occupational Asthma

Fractional exhaled nitric oxide (FENO) measurements are recommended for the assessment of eosinophilic airway inflammation in asthma. Clinically relevant increases in FENO have been reported 24 h after positive specific inhalational challenge (SIC) tests in occupational asthma. We aimed to determine whether positive SICs could be discriminated from control tests, on the basis of change in FENO. We reviewed all positive SICs to a variety of agents performed at our institution 2008-2012 and gathered data on age, sex, asthmatic response (immediate/dual/late), smoking status, inhaled corticosteroid usage, and FENO pre- and 24-h postcontrol and positive SIC from each worker. Changes in FENO after positive SICs were compared with control SICs from each worker, by using paired Student's t tests. In 16 workers, negative control challenges were associated with mean changes in FENO of 9 % (95 % CI -1.14 to 19.01) or 1.1 ppb (95 % CI -3.59 to 5.84); 2 of 16 (13 %) workers tested showed increases in FENO that were clinically relevant based on recent guidelines. Subsequent positive SICs were associated with mean changes in FENO of 7 % (95 % CI −15.73 to 29.6) or 2.1 ppb (95 % CI -6.07 to 10.19), which were not significantly different to controls; only 2 of 16 (13 %) workers had FENO changes that were clinically relevant. FENO changes above the upper confidence limits of ≥20 % or ≥6 ppb may be considered to be outside the range of normality. However, the majority of workers who had clearly positive SICs to common low molecular weight agents also had no statistically or clinically relevant increase in FENO. Therefore, change in FENO does not predict a positive SIC in this group.

Diagnosis and frequency of work-exacerbated asthma among bakers

BackgroundWork-exacerbated asthma (WEA) is asthma worsened by workplace exposures, although the asthma is not caused by sensitizers in the work environment. ObjectivesTo evaluate the frequency of WEA in bakers reporting work-related respiratory symptoms and the usefulness of diagnostic tests in differentiating WEA from occupational asthma (OA). MethodsThe study group included 393 bakers reporting respiratory symptoms at the workplace. In all patients, questionnaire, spirometry, skin prick tests (SPTs), and evaluation of serum total and specific IgE levels were performed. Recognition of OA was based on a specific inhalation challenge test. ResultsOccupational asthma was found in 44.5% of patients, whereas WEA was recognized in 16%. The latency period was 11.2 ± 8.2 years in patients with OA vs 13.3 ± 9.7 years in those with WEA. Sixty percent of patients with OA and 50.8% of those with WEA had positive SPT reactions to common allergens; occupational SPT results were positive in 74.9% and 34.9%, respectively. Specific IgE to flours were found in 61.7% of patients with OA and 28.6% of those with WEA. In addition, OA frequently coexisted with occupational rhinitis (53.7% of patients), whereas WEA and rhinitis were found in 31.7% of patients. ConclusionWork-exacerbated asthma was diagnosed in 16% of bakers who reported allergic respiratory symptoms. The specific challenge test for occupational allergens should be performed in bakers with suspected work-related asthma, because an assessment of sensitization (SPT to occupational allergens, evaluation of specific IgE) is not specific enough to differentiate OA from WEA.

Mast cells and basophils are essential for allergies: mechanisms of allergic inflammation and a proposed procedure for diagnosis

The current definition of allergy is a group of IgE-mediated diseases. However, a large portion of patients with clinical manifestations of allergies do not exhibit elevated serum levels of IgE (sIgEs). In this article, three key factors, ie soluble allergens, sIgEs and mast cells or basophils, representing the causative factors, messengers and primary effector cells in allergic inflammation, respectively, were discussed. Based on current knowledge on allergic diseases, we propose that allergic diseases are a group of diseases mediated through activated mast cells and/or basophils in sensitive individuals, and allergic diseases include four subgroups: (1) IgE dependent; (2) other immunoglobulin dependent; (3) non-immunoglobulin mediated; (4) mixture of the first three subgroups. According to our proposed definition, pseudo-allergic-reactions, in which mast cell or basophil activation is not mediated via IgE, or to a lesser extent via IgG or IgM, should be non-IgE-mediated allergic diseases. Specific allergen challenge tests (SACTs) are gold standard tests for diagnosing allergies in vivo, but risky. The identification of surface membrane activation markers of mast cells and basophils (CD203c, CCR3, CD63, etc) has led to development of the basophil activation test (BAT), an in vitro specific allergen challenge test (SACT). Based on currently available laboratory allergy tests, we here propose a laboratory examination procedure for allergy.

Occupational Asthma in Female Factory Worker Resulting from Exposure to Savinase in Dishwashing Tablets—A Case Study

Savinase is one of the endopeptidases widely used in washing detergents. Its ability to cause respiratory allergy has been known. Up to now, most cases of occupational asthma (OA) to savinase have been described among workers involved in the manufacture of laundry detergents. We present a case study of 51-year-old female worker of a dishwashing tablets factory, who had been packaging ready-made tablets into foil wrappers for 4 years and developed respiratory symptoms, such as cough, dyspnoea and wheezing. A number of clinical procedures were performed, including the clinical examination, routine laboratory tests, evaluation of total and allergen-specific serum IgE (asIgE) to enzymes, skin prick tests for common allergens, rest spirometry, inhalation methacholine challenge test and a single-blind, placebo-controlled specific inhalation challenge test (SICT) with dishwashing tablets. Clinical findings and results of routine laboratory tests were within normal limits. Baseline nonspecific bronchial hyperreactivity was revealed. In patient's serum blood we found significantly elevated asIgE to savinase. Decline of FEV1 and PEF in late phase of asthmatic reaction was observed during the specific challenge test. The patient reported chest tightness between 5-12 hours after exposure to dishwashing tablet ingredients. Cytological assessment of an induced sputum revealed increase in the percentage of eosinophils 24 hours after specific challenge in comparison to values noted before the SICT. Positive clinical response to the challenge confirmed in objective method tests validated the diagnosis of OA.

Chlorhexidine--still an underestimated allergic hazard for health care professionals

Chlorhexidine is a low molecular weight occupational sensitizer that can cause different delayed and immediate-type allergic reactions including anaphylaxis. It is widely used as an antiseptic and disinfectant and not only in the occupational environment as it is present in toothpaste, mouthwash, nose and eye drops and ointments. We present three cases of occupationally exposed workers with airway allergy to chlorhexidine. The role of chlorhexidine as an occupational allergen was confirmed by placebo-controlled specific inhalative challenge tests monitored by spirometry and analysis of induced sputum (influx of eosinophils after provocation has been observed). One of these patients presented with a systemic reaction with ordinary environment exposure. These findings are a reminder to clinicians of chlorhexidine's ability to cause various hypersensitivity reactions and the potential risk of this widely used antiseptic.

Mould Sensitisation among Bakers and Farmers with Work-related Respiratory Symptoms

Fungi belong to common allergens, which can be found both in occupational and non-occupational environment. The aim of the study was to determine the frequency and factors associated with mould allergy among bakers and farmers reporting work-related respiratory symptoms. The study group comprised 117 bakers and 83 farmers reporting work-related respiratory symptoms. Skin prick tests (SPT) with common, fungal and occupational allergens, estimation of serum total IgE level, spirometry, histamine test and specific inhalative challenge test with occupational allergens were performed in all subjects. The prevalence of hypersensitivity to fungal species was higher among farmers (32.5%) than bakers (16.2%). Positive SPT with mould allergens were found among 10.8% farmers and 6.8% bakers with occupational allergy. The fungi allergens giving positive SPT results most frequently were Candida albicans, Levures mélanges, Aspergillus mix. and Charbons cerealiers in both groups. Among mould allergens, hypersensitivity to Aspergillus genus was the most common in farmers and bakers group, while among Saccharomyces - Candida albicans sensitization was the most frequently detected. Mould hypersensitivity is related to occupational respiratory allergy, especially to asthma and rhinitis in farmers, and occupational asthma in bakers. Although sensitization to Saccharomyces was more frequent, similar correlation was not observed.

Assessment of Commercial Specific IgE Assay for Detection of Allergens in Allergic Patients

Allergy is a serious health problem throughout the world, affecting people of all ages. Allergic diseases such as asthma, rhinitis and atopic dermatitis are becoming an epidemic in our country, the cost of investigating these diseases is increasing and becoming expensively high. There are many ways to explore allergenic antibodies to assess the presence the amount of specific IgE as: Skin test (Prick), Specific IgE (ELISA), RAST Sp.IgE and Elimination Challenge method. Skin test produces pain, local and anaphylactic reaction and patient discomfort, other procedure with highly cost to patient. So, we have built up an evidence to use it in our allergy and immunology clinic has suitable cost for all patients based about for the other tests but it was very simple, accurate, cheap and does not produce any problems to patients. Our test depends on ELISA technique, it measures the quantitative amount of the following different allergens: As regard food allergens: Milk, Eggs, Banana, Maize, Fish, Chocolate, Wheat, Nuts, Strawberry, Shrimps, Spices, with drug as Aspirin. As regard inhalants as: House dust, Mite, Mixed Pollens, Mixed Moulds, Hay dust, Wool, Latex and Cat Hair. 150 allergic patient results of our test compared with specific IgE national kits (ELISA), Sp.IgE (RAST), Skin test and elimination challenge test. The statistical evaluation results as regard senistivity respectively: 88.9%, 89.6%, 91.2%, 71.4%, 93.1%. As regard specificity the results: 93.1%, 94.7%, 95.3%, 65.5%, 91.6%, the latter results showed that our test was in line with all tests. Our test was probably in food, drug and inhalant allergens, it can be also noted that the cheapest and most commercial technique was used, so as to be available immediately in standard laboratory and its reagents, plate and other requirements were prepared locally in our laboratory. Now it was applying successfully in allergy and immunology unit Ain Shams university hospitals in Egypt.