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Notizen: The effect of a single inhalation of allergen on bronchial reactivity to polymyxin B was studied in eight patients with hay fever. In winter the reaction to polymyxin B before and after inhalation of pollen allergen is measured by the FEV. In all patients bronchial reactivity to polymyxin B increased under the influence of allergen.

Notizen: Background: Eotaxin and MCP-3 (CC chemokines), owing to their preferential action on eosinophils, seem to be the very importance in the patophysiology of allergic rhinitis and asthma. The purpose of this study was to examine the effect of intranasally administered eotaxin and MCP-3 after specific allergen priming on the influx of inflammatory cells and their soluble mediators into the nasal mucosa.Methods:  Eotaxin and MCP-3 have been applied intranasally at the increasing doses of 1, 5 and 10 µg to allergic patients after allergen priming. The ‘nasal pool’ technique was used. The cell count and biochemical parameters in nasal lavage were evaluated before 30 min, and 4 and 24 h after the challenge with chemokines.Results:  Both eotaxin and MCP-3 induced the increase in clinical ‘score’ lasting till 24 h. Eosinophil influx into nasal mucosa after provocation with eotaxin was also observed. The challenge with MCP-3 did not induce any significant changes in nasal lavage fluid.Conclusions:  Eotaxin is likely to play an important role in the pathogenesis of allergic conditions in humans. MCP-3 did not induce inflammatory cell influx into nasal mucosa. The role of this chemokine in the pathogenesis of allergic inflammation is difficult to assess and requires further studies.

Notizen: Background: Glutaraldehyde (GA) is a known respiratory sensitizers, and some studies have reported occupational asthma in exposed workers. Specific changes in nasal lavage fluid (NLF) induced by high-molecular-weight allergen provocation in sensitized subjects were described previously. The purpose of this study was to evaluate the changes in cytogram, protein content, eosinophil cationic protein (ECP), and mast-cell tryptase concentrations in NLF after GA inhalation challenge in patients with a positive history of GA-induced asthma and late or dual asthmatic response due to exposure to low-level GA. Methods: A single-blind, placebo-controlled study was performed on 11 health workers with occupational asthma and rhinitis due to GA. The control groups comprised 10 atopic subjects with perennial asthma and rhinitis and 10 healthy ones. A “nasal pool” technique was used to evaluate the examined parameters in nasal washings before and 30 min, 4 h, and 24 h after the inhalatory provocation with GA and placebo. Results: There was a significant increase in eosinophil number and percentage, and albumin, ECP, and tryptase concentrations in NLF from patients with occupational asthma and rhinitis when compared to controls. Conclusions: The results indicate the immunologic mechanism of GA-induced asthma and the applicability of the “nasal pool” technique as the diagnostic procedure in GA-induced airway allergy.

Notizen: A case of occupational bronchial asthma due to morphine in a nonatopic 46-year-old woman is presented. The following diagnostic tests were used: a workplace trial with bronchodilator and placebo, and single-blind, placebo-controlled nasal and bronchial challenge with 0.5% morphine HCl. For the nasal challenge, four asthmatic patients were selected as a control group. The nasal washings were done before and 30 min, 3 h, 24 h, and 48 h after all challenges. In the nasal lavage fluid, the total numbers of eosinophils, neutrophils, basophils, and mast cells were counted, and, after the nasal challenge, total protein and albumin levels were measured. During the workplace trial, the PEF variability ratio increased from 5% to 38%. After the challenges, a decrease in the spirometric parameters (VC and FEV1) of about 30–40% was observed, with minimums at 24 and 48 h. An influx of granulocytes with an increase in the relative number of eosinophils and basophils from 3 h until 48 h after the challenge was observed in the nasal lavage fluid. The protein level in the nasal lavage fluid increased from 190 to 1275 μg/ml 24 h after the challenge with an increase of relative albumin level from 24% to 40% at 24 h. In the control group, no changes in relative number of basophils and eosinophils and albumin/total protein ratio in the nasal lavage fluid or in the spirometric parameters were observed after the challenge.

Notizen: Background: The aim of our study was to compare clinical significance and economical factors of commonly used standard skin prick tests (SPT) method with new, modified and more handy way of performing SPT.Methods: Twenty-one subjects [with an average age of 23 years (SD ± 2.72)] with known sensitivity to examined allergen extracts were tested with histamine, negative control solution and standard allergen extracts (Allergopharma, Reinbeck, Germany). SPT were applied to the volar surface of randomly assigned forearm with two methods: standard technique using lancet needle to prick the epidermis under small drop of extract and tested method using lancet needle which was dipped in extract before prick. In this method all extracts were placed in marked, small, plastic chambers.Results: Mean wheal to histamine was 5.49 (standard method) and 5.01 (modified method). There was no statistical difference between the standard and modified method for size of wheal to histamine (P = 0.654) and to allergen extracts (n = 36, P = 0.824, Wilcoxon test). Economical analysis revealed that examined SPT technique is cheaper than standard method.Conclusion: Examined method may be considered to be an alternative for performing SPT as it is safe, cheaper and more convenient than standard technique. Summary statement: Comparison of standard and modified SPT method revealed the new method to be more economical.

Notizen: Background:  This prospective study describes the incidence, risk factors and natural history of occupational respiratory allergy in apprentice bakers.Methods:  Two hundred and eighty-seven apprentice bakers were examined using a questionnaire, skin prick tests (SPTs) to common and occupational allergens, evaluation of total serum IgE level and specific anti-flour and α-amylase IgE, before, 1 year and 2 years after the onset of vocational training. To diagnose occupational respiratory disease, spirometry, histamine and allergen-specific inhalation challenge tests were performed.Results:  The incidence of work-related chest symptoms was 4.2% in the first year and 8.6% in the second year of exposure. Hypersensitivity to occupational allergens developed in 4.6 and 8.2% of subjects, respectively. The incidence of occupational allergic rhinitis was 8.4% after 1 year and 12.5% after 2 years, and that of occupational asthma/cough-variant asthma 6.1 and 8.7%, respectively. The latency period of work-related rhinitis symptoms was 11.6 ± 7.1 months and chest symptoms 12.9 ± 5.5 months. Only in 20% of occupational asthmatics could allergic rhinitis be diagnosed a stage earlier. In 21 out of 25 subjects with occupational asthma, chronic cough was the sole clinical manifestation of the disease. Stepwise logistic regression analysis revealed that positive SPT to common allergens was a significant risk factor of hypersensitivity to occupational allergens (OR = 10.6, 95% CI 5.27; 21.45), occupational rhinitis (OR = 3.9, 95% CI 1.71; 9.14) and occupational asthma (OR = 7.4, 95% CI 3.01; 18.04). Moreover, positive SPT to occupational allergens on entry to the training was a significant risk factor of asthma (OR = 6.9, 95% CI 0.93; 51.38).Conclusions:  The incidence of occupational asthma and rhinitis in apprentice bakers is high and increases z with the duration of exposure. Skin reactivity to common and occupational allergens is the main risk factor of bakers’ asthma. Most cases of work-related respiratory symptoms among apprentice bakers are related to a specific sensitization. In most subjects who developed occupational asthma, rhinitis occurred at the same time as the chest symptoms did.

Notizen: Background:  The aim of our study was to investigate effects of 6-week pretreatment of seasonal allergic rhinitis (AR) with cetirizine, and montelukast, alone and in combination. Antihistamine/antileukotriene treatment is effective in AR. Antihistamines may prevent AR symptoms while prophylactic activity of antileukotrienes remains unclear.Methods:  Sixty AR patients, aged 18–35 years, were randomized to receive placebo, montelukast only, cetirizine only, or montelukast plus cetirizine, 6 weeks prior and 6 weeks after the beginning of grass pollen season. Mean self-recorded in-season symptom scores and mean weekly all-symptom scores were analyzed. In 31 patients, nasal lavages were performed before treatment, and at the end of the study, i.e. 12 weeks after the treatment initiation. Eosinophil and basophil counts, eosinophil cationic protein (ECP), and mast cell tryptase (MCT) levels were evaluated in lavage samples.Results:  Combined montelukast/cetirizine pretreatment significantly reduced in-season symptom score for sneezing, eye itching, nasal itching, rhinorrhea, and congestion. Montelukast plus cetirizine were more effective than cetirizine alone in preventing eye itching, rhinorrhea, and nasal itching. Moreover, combined pretreatment with montelukast and cetirizine delayed appearance of AR symptoms. Eosinophil nasal lavage fluid counts were significantly increased during pollen season in placebo and montelukast-only groups. No differences were observed in basophil counts. The in-season ECP level was significantly increased in all groups except montelukast-plus-cetirizine group. In-season MCT levels were not increased.Conclusion:  Combined antihistamine and antileukotriene treatment started 6 weeks before the pollen season is effective in preventing AR symptoms and reduces allergic inflammation in nasal mucosa during natural allergen exposure.

Notizen: Background:  Asthma morbidity increases every year, especially among children, and exposure to high levels of indoor allergens is a very important factor. We evaluated the prevalence and exposure to cockroach (CR) allergen in asthmatic children in Poland, and also tested the hypothesis that asthma with allergy to CR is more severe than with allergy to other antigens. Methods:  One hundred and sixty children with asthma were examined, had skin prick tests (SPT) with common and CR allergens, underwent spirometry, and provocation tests to histamine. Children with positive SPT to CR had measured specific IgE levels to this antigen and Bla g 2 concentrations were measured in their homes. Results:  The most common allergen, was dust mite 51.3%, followed by pollen 48.8% and CR allergen 24.3%. In children with CR sensitivity, 13% had mild asthma, 26% moderate and 61% had severe asthma. Their levels for forced expiratory volume in one second (FEV 1 ), and the provocative concentration of histamine that caused a 20% fall in FEV 1 (PC 20 ), were statistically lower than in the group of children with other than CR allergies. Bla g 2 antigen was detected in 55.13% samples. The highest levels of Bla g 2 were found in old houses, without central heating, and in houses with lower income. Conclusion:  In Polish children, CR allergen is a very important factor of sensitivity. Concentrations of Bla g 2 in homes are higher than previously reported in other European countries, and are strongly related to the houses' characteristics. Also, children with CR hypersensitivity have severe asthma more often than children with other allergies.

Notizen: Background: Natural rubber latex (NRL) allergy in workers using rubber gloves has been an occupational health problem for the last 10 years. In the case of the occupational agents, clinical history may be far from conclusive; hence, appropriate provocation should be carried out. The objective was to evaluate the usefulness of the nasal challenge test in the diagnosis of allergic rhinitis in subjects occupationally exposed to NRL. Methods: A single-blind, placebo-controlled study was conducted in 16 nurses with respiratory symptoms (bronchial asthma and/or rhinitis) related to NRL exposure as well as positive skin prick test (SPT) response to NRL. The controls were nine nurses with asthma and/or perennial rhinitis unrelated to NRL exposure; six atopic patients not occupationally exposed to NRL, with asthma and/or perennial rhinitis; and six healthy subjects. All the controls had negative results of SPT with NRL. Patients with a history of anaphylaxis or positive results of RAST to NRL were not considered in the study. The “nasal pool” technique was used to evaluate the cellular response and changes in protein level and ECP concentration in nasal washings after topical provocation with allergen or placebo. Results: A significant increase was noted in eosinophil and basophil number, albumin/total protein ratio, and ECP level only in NRL SPT-positive patients subjected to nasal challenge with NRL. Neither bronchial nor systemic reactions were found after the nasal provocation with NRL. Conclusions: The nasal challenge test appears to be useful for diagnosing occupational rhinitis in NRL-sensitized patients.