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Background: Fungal components can cause allergic symptoms either through inhalation, ingestion or contact. Allergic disease from occupational exposure to Boletus edulis (BE) has only seldom been reported., Objectives: Report on a female worker who developed respiratory and skin symptoms from occupational exposure to BE in selecting and packing dried mushrooms. She never had symptoms after eating mushrooms., Methods: An environmental study was performed by personal air samplings and settled dust collection. The RAST-inhibition procedure was used to detect BE allergen potency in collected dust. The subject underwent clinical evaluation, spirometry, skin prick-tests, RAST methacoline and specific inhalation challenge with BE extract. A follow-up study was made 2, 4 and 8 months after the first evaluation and after cessation of exposure., Results: BE allergens were found in the settled dust. Clinical examination showed eczema on the face and hands. The worker had hyper-eosinophilia, bronchial hyper-responsiveness to methacoline, no allergy to common inhalants and foods, positive prick-test and RAST for BE. The specific inhalation challenge induced broncho-constriction. At follow-up we observed a progressive clinical and functional improvement., Conclusions: Our data show that BE can induce cutaneous and respiratory symptoms from occupational exposure to dried mushroom dusts. The pathogenesis is an IgE-allergy. Our patient had no symptoms from ingestion, which supports the hypothesis that respiratory allergy is due to mushroom antigens that differ from those involved in food-related allergic reactions.

The study was designed to assess the spontaneous recovery of bronchial spasm induced by methacholine in bronchial challenge tests and to examine the mechanisms and the modalities involved as well as the influence of dosage. The phenomenon was analysed in 32 hyperreactive patients diagnosed as asthmatics by measuring FEV1 as soon as maximum bronchial constriction (PD20) had been achieved and after 5, 10, 15, 30 and 60 minutes. The data obtained were subjected to variance analysis. Results show: 1) as regards duration of spontaneous recovery, that FEV1 returned to pre-challenge levels after 60 minutes in both the severely and moderately hyperreactive patients; 2) as regards onset of regression, that onset depended on the level of sensitivity, occurring after 30 minutes in the severely affected, after 15 minutes in the mild cases; 3) as regards recovery intensity, that in the moderated cases the recovery was more pronounced in the first 15 minutes than subsequently. Data show that the onset and intensity of the spontaneous recovery change according to the degree of sensitivity. That might reflect a greater affinity and/or bonding of methacholine in the muscarinic receptors of the severely affected, but the possibility of a difference in mediator metabolization speed cannot be excluded. In conclusion, research into the recovery of bronchial spasm may contribute to a better understanding of bronchial hypersensitivity and provide new information of value on the diagnosis, pathogenesis and treatment of the condition.

The contribution of beta 2-agonist treatment per se and the effect of beta 2-agonists plus allergen exposure was evaluated in two groups of thirteen asthmatic children being treated respectively at sea level during the period of maximal allergen exposure and at high altitude in an environment free of the offending allergens. Bronchial hyperreactivity was evaluated by standardised exercise tests before and after treatment with salbutamol controlled release tablets (4 mg). Challenges were performed at the beginning and after 2 and 4 weeks of treatment. A fourth test was performed 2 days after stopping the treatment. Children treated with salbutamol at sea level (exposure to allergen) showed baseline delta PEF of 16.9 +/- 3.4 and 13.7 +/- 4.2, 20.7 +/- 4.3, 26.0 +/- 5.1 respectively for the second, third and fourth test. Children treated at high altitude showed respectively delta PEF of 34.9 +/- 5.1, 31.1 +/- 4.9, 26.5 +/- 5.4, 27.9 +/- 5.0. These data suggest that oral salbutamol per se is not responsible for an increase in bronchial responsiveness, but eventually suggest that treatment with beta 2-agonists at the same time as continued allergen exposure may be responsible for an increase in bronchial hyperresponsiveness.

Bronchial hyperresponsiveness (BHR) reflects an exaggerated sensitivity of airways to pharmacologic and/or physical stimuli. Patients with symptomatic asthma often have a higher degree of BHR than nonasthmatics, even though BHR shows a variable relationship with the clinical expression of the disease and with medication requirements. Methods of bronchial challenge, initially developed in adults, are increasingly employed also in children. The Authors discuss the clinical significance of the evaluation of bronchial responsiveness in the diagnostic approach and follow-up of children with asthma. Some methodological aspects and limits of bronchial challenging in childhood are expecially addressed.

In recent years there was an increased need for accurate information on the health effects of inhaled pollutants. Biologic markers (i.e. indicators of events in biologic systems) can be a useful tool to measure the effects of environmental pollutants. Lung function parameters, bronchial responsiveness, immune system status and respiratory symptoms can be considered as indicators of respiratory health. In this brief review, several methods are discussed in relation to the use in epidemiological studies.