Poster
# 85
Poster |
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6th Internet World Congress for Biomedical Sciences |
Pedro Angel Galindo(1), Elisa Gómez(2), Francisco Feo(3), Jesús Borja(4), Rosa García Rodriguez(5)
(1)(2)(3)(4)Complejo Hospitalario Ciudad Real - Ciudad Real. Spain
(5)Allergy Section. Complejo Hospitalario Ciudad Real - Ciudad Real. Spain
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[Allergy & Clinical Immunology] |
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[Occupational Health] |
Psyllium (PS) or ispaghula is derived from the seed husk of Plantago ovata. It is available as fiber laxative, bulk-forming. IgE-mediated hypersensitivity to PS (asthma, rhinitis and anaphylaxis) have been described in nurses dispensing PS containing laxative to patients (1-5), in workers of pharmaceutical industries processing PS (6,7) and, from ingestion of PS laxative (1,5,8).
Case 1.- A 27-year-old woman, a nurse who had worked for 3 months in a geriatric residence a year before she was seen in our allergy section. Two months after the work started she suffered bronchial asthma which got worse when she gave the old people a powder laxative containing PS seeds (PlantabenR). She did not smoke and she had no personal or family history of atopic diseases. The symptoms disapeared after she stopped working in the geriatric residence. In the study undertaken we should point out a eosinophilia of 600/mm3, total IgE was 580 kU/l, specific IgE against PS (Pharmacia Diagnostics, Uppsala, Sweden) was also negative. Methacolina inhalation test was negative to 800 AU. Skin prick test (SPT) with PS extract (1:10 w/v) was positive (6x5 mm), histamine (5x4 mm). SPT with common aeroallergens were negative.
The PS exposure test was carried out poured out 17.5 gr of dust PS from one disposable bowl to another. This test showed an immediate reaction., after 5 min. the FEV1 dropped by 28%, by 35% after 10 min. and, by 43% after 15 min. It was accompanied by cough, intense dyspnea and wheezing. The patient improved by inhaling albuterol and with corticosteroids intravenously after 15 min. and all levels were back to normal after 1 hour. No later reaction was observed.
Case 2.- A 33-year-old woman, a nurse working in the same geriatric residence as patient no.1. She smoke 20 cigarretes per day. She had no personal history of atopic disease but she had a brother with atopic asthma. When she dispensed a powdered laxative containing PS seeds (PlantabenR) to old people. she suffered itching in throat, rhinorrea, blocking of noses, cough, wheezing and dyspnea after 8-10 h. of exposure to PS. Currently the symptoms start 15 min. after PS handling and last all day being slightly better on non-working days. She has used a facemark but to little effect. The physical examination when the patient was working revealed wheezing.
The Peak-Flow control at home and at work showed a clear deterioration when she was handling PS. The blood cell count was normal, total IgE was 83 kU/l, she showed high levels of specific IgE against PS (1.42 kU/l). Methacholine inhalation test revealed mild bronchial hyperresponsiveness, (PD20 = 70 AU). The SPT with PS extract was positive (12x6 mm), histamine (5x6 mm), it were negative with the common aeroallergens.
The PS exposure test (she poured out 7 gr of dust PS) showed an immediate and late reaction. After 10 min. handling PS, the FEV1 decreased by 32% and the patient suffered from cough and wheezing, she improved in 15 min. after inhaling albuterol and all levels were back to normal in 1 hour. She also showed conjunctival itching with redness and sneezing. After 8 h. the Peak-Flow dropped by 28% and there was cough, dyspnea and wheezing, which stopped after inhaling albuterol. The patient has had no further symptoms since the laxative that contained PS was removed from his workplace.
The seeds of Plantago ovata (Psyllium or ispaghula) are turned into a fine dust to prepare bulk laxatives, which are used by millions of people all over the world. The powdered PS seed is a potent allergen that can produce IgE-mediated hypersensitivity when is inhaled by nurses dispensing PS to patients (1-5) and in workers of pharmaceutical industries processing PS (6,7).
We report on 2 new cases of nurses with occupational asthma IgE-mediated by PS. The sensitization IgE-mediated has been clearly demonstrated in patient no.2 (positive SPT and elevated levels of specific IgE againts PS). The patient no.1 showed a positive SPT with PS but specific IgE was negative, we think this is due to the time that has passed without being exposed to PS. In our 2 patients we demonstrate that the PS was the responsible antigen in exposure tests, we found a dual reaction (immediate and late) in patient no.2. The patient no.1 showed an isolated immediate reaction, although the use of corticosteroids after that reaction could have avoided the developed of late bronchial response.
Although occupational asthma from exposure to ispaghula dust has been described before, we considered it interesting to report on these 2 new cases for the following reasons: 1) to draw attention to the fact that in cases of respiratory allergy who are in contact with laxatives containing inpaghula, sensitization to this should be studied. 2) The pharmaceutical industry the should change the form in which tis drug is presented, as if it were marketed in the form of granules this would avoid the inhaling of the dust.
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[Allergy & Clinical Immunology] |
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[Occupational Health] |
