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Psyllium (from Plantago ovata; ispaghula) is used as a dietary supplement and is supplied in the form of husk, granules, capsules, or powder. Consumers using psyllium-containing laxatives, healthcare workers handling these, and pharmaceutical workers in laxative-manufacturing plants are known to be at risk of sensitization and subsequent rhinitis, asthma, contact urticaria, and even anaphylaxis. To our knowledge, the case we present here is the first of baker's immunoglobulin E (IgE)-mediated occupational allergy due to psyllium exposure. Our patient, a 24-year-old female baker with no previous allergies, was referred to our clinic with suspected occupational rhinitis. After 1 year of baking with cereal flour or gluten-free flour-mix, she began to suffer from rhino-conjunctival symptoms during workdays. Skin prick tests with agents from the patient's workplace revealed allergies not only to wheat and rye flours but also to psyllium, with a remarkable 10 mm wheal. Subsequently, nasal provocation tests confirmed occupational allergic rhinitis to psyllium. We also found work-related sensitization to buckwheat, which she used in gluten-free baking. Due to the increased prevalence of celiac disease and the popularity of gluten-free and vegan food, psyllium has recently become a common ingredient in baking, used as a substitute for gluten or eggs. Bakers handle allergens such as these in high concentrations and this may lie behind the emergence of respiratory and dermal symptoms. It is essential to consider new or recenlty introduced materials as possible allergens if it is suspected that a baker has work-related respiratory or allergic symptoms.

Buckwheat is a known, though uncommon, allergen in occupational settings. It has recently gained popularity as healthy food and as an ingredient in gluten-free diets. We describe a series of six patient cases with occupational immediate allergy to buckwheat. Three cooks, two bakers, and a worker in a grocery store were occupationally exposed to buckwheat flour and developed immediate allergy to buckwheat, which was confirmed by skin prick testing and measurement of specific immunoglobulin E antibodies. Four of the patients were diagnosed with occupational asthma, four with occupational rhinitis, and two with occupational contact urticaria caused by buckwheat. Three of the six patients suffered anaphylaxis as consequence of their occupational buckwheat allergy after ingestion of food that contained buckwheat. The high rate of life-threatening reactions, together with a short exposure time to buckwheat before sensitization occurred in these cases, highlights the importance of a detailed occupational history and a high index of suspicion for occupational food allergens.

Background: Seasonal allergic rhinitis (SAR) caused by intermittent exposure to seasonal pollen causes itching, nasal congestion, and repeated sneezing, with profound effects on quality of life, work productivity, and school performance. Although both the genotype and environmental factors can contribute to the immunologic basis of allergic reactions, the molecular underpinnings associated with the pathogenesis of allergic rhinitis are not entirely clear. Methods: To address these questions, nasal epithelial brushings were collected from 29 patients with SAR and 31 control subjects during and after the pollen season. We then implemented an orbitrap-based, bottom-up, label-free quantitative proteomics approach, followed by multivariate analyses to identify differentially abundant (DA) proteins among the 4 sample groups. Results: We identified a total of 133 DA proteins for which the most significantly overrepresented functional category was found to be interferon 1 signaling. Two proteins, cystatin 1 and myeloblastin, the former of which protects against protease activity of allergens and the latter with a role in epithelial barrier function, were DA in patients with SAR and control subjects, irrespective of season. Moreover, interferon-inducible protein with tetratricopeptide repeats 1, cystatin 1, and interferon-inducible protein with tetratricopeptide repeats 3 were found to be differentially regulated between patients with SAR and control subjects, with inverse abundance dynamics during the transition from fall to spring. Conclusion: We identified type 1 interferon-regulated proteins as biomarkers in patients with SAR, potentially playing an important role in its pathogenesis. Moreover, when compared with patients with SAR, healthy subjects exhibit an antagonistic proteomic response across seasons, which might prove to be a therapeutic target for disease prevention.

We describe four cases of slaughterhouse workers with occupational immediate allergy to raw pork allergens, confirmed by positive skin prick testing and specific immunoglobulin E (IgE) antibodies. Our first patient was diagnosed with occupational asthma from raw pork allergens. Two patients were diagnosed with occupational rhinitis caused by raw pork allergens, which was confirmed by a nasal provocation test. One of these also had occupational contact urticaria caused by raw pork meat. We were unable to diagnose an occupational respiratory or skin disease in the fourth patient, despite signs of immediate sensitization to raw pork meat from occupational exposure. Based on proper diagnoses, measures to prevent allergen exposure were taken, which led to the improvement of symptoms in these four patients. The present patient cases highlight the importance of recognition of early signs of occupational allergy and identification of causative allergens in order to allow avoidance of allergens, with the aim of preventing persistence and worsening of symptoms.

No allergens related to paprika or cayenne respiratory allergy have been identified thus far. We describe a previously healthy 28-year woman who developed work-related rhinoconjunctivitis after four years of kebab-restaurant work. The allergy was studied using skin prick tests, serum specific IgE and nasal provocation tests. Specific IgE protein reactions were studied by Western blot analysis. Paprika, cayenne and curry allergens were identified from the strongest immunoblot bands using tandem mass spectrometry. A positive skin prick test, high specific IgE and positive nasal provocation test confirmed occupational rhinoconjunctivitis from Capsicum spices. Defensin J1 and Vicilin were identified as major paprika and cayenne allergens in this case. Vicilin was detected also from the curry ingredients. Two new occupational respiratory allergens from the Capsicum species were identified. These differ from previously reported bell pepper allergens. We emphasize that substantial spice handling at work poses an allergy risk. Am. J. Ind. Med. 58:791–794, 2015. © 2015 Wiley Periodicals, Inc.

Background: The inconsistency of commercial bovine dander extracts hampers the diagnostics of IgE-mediated occupational allergies. Aim: Aim was to investigate whether the in-house extract improves the diagnostics of occupational immediate allergies and reveals new information regarding bovine allergens. Methods: Altogether 102 patients with a suspected bovine-related occupational rhinitis, asthma and/or contact urticaria underwent skin-prick tests (SPTs) with in-house and available commercial bovine dander extracts. The nasal provocation test (NPT) was performed on 31 of the patients to confirm possible occupational rhinitis. The score changes of ≥ 4 point in the bilateral nasal secretion and blockage seen in anterior rhinoscopy were considered positive. Specific IgE- protein reactions from the serums of patients with positive NPTs were studied and allergens were identified from the strongest immunoblot bands using tandem mass spectrometry. Results: The in-house SPT extract yielded more positive reactions (≥ 3mm wheal) than the two commercial agents (44% vs 34% and 11%, p=0.006 and 0.001 respectively). Of the 21 patients who underwent NPTs to both in-house and commercial extract, 13 (62%) reacted only to the in-house extract, whereas five (24%) reacted to both extracts (p Conclusions: The rich allergen content of allergen extracts improves the diagnostic accuracy of immediate allergies to bovine dander. In-house bovine dander extracts are needed in the diagnostics of occupational allergies.

Background Baker's asthma and rhinitis are among the most common occupational diseases. Inhaled cereal flours, such as wheat, especially cause this disease. Objective To identify and test in vivo clinically important wheat allergens in baker's respiratory allergy in a Finnish population. Methods Potential wheat allergens were purified using chromatographic methods from salt-soluble protein extracts of wheat flour and were used in skin prick tests with serial 10-fold dilutions (0.5–0.005 mg/mL). Twenty patients with baker's rhinitis, asthma, or both participated in this study. All the patients had positive skin prick test reactions and specific IgE antibodies to wheat flour. The control group consisted of 10 healthy individuals. Molecular identities of purified wheat allergens were characterized using sodium dodecyl sulfate–polyacrylamide gel electrophoresis and tandem mass spectrometry. Results Allergen concentrations of 0.3–0.5 mg/mL revealed that 12 patients reacted to α-amylase inhibitor (α-AI), 9 to peroxidase I (PI), 9 to thaumatin-like protein (TLP), and 6 to lipid transfer protein 2G (LTP2G). Conversely, with allergen concentrations of 0.05 mg/mL, 5 patients responded to α-AI, 3 to PI, 4 to LTP2G, and 6 to TLP. Of these, TLP and LTP2G are now observed to be new allergens associated with baker's asthma. Conclusions In addition to the earlier-described α-AI and PI, TLP and LTP2G are important in vivo wheat allergens in baker's allergies in Finland. Further studies are needed to elucidate the role of these novel wheat allergens in respiratory disorders.

We have observed a 49 bp tandem duplication adjacent to the triplet repeat of the FMR1 gene and have shown it to occur as a variant in Finland. It affects the primers commonly used in molecular analysis of fragile X syndrome by polymerase chain reaction (PCR) methods. One concern is that females with the full mutation and variant alleles might be missed because of the two PCR products generated by the variant. We suggest that the duplication has arisen by a misalignment of the proximal end of the repeat tract and the non-adjacent GGCGGCGGCGG-sequence located 37 bp upstream and may indicate a mutation hot spot. The discovery of this duplication and the previous observations on deletions associated with full mutations in FMR1 indicate that realignment between the repeat tract and dispersed non-adjacent homologous repetitive sequences may also play a role in repeat instability in fragile X.

We report a patient presenting with myelitis after respiratory symptoms. A high level of antibodies to influenza A virus was measured in serum and cerebrospinal fluid (CSF), and the serum/CSF antibody ratio was 1.7, suggesting specific antibody production in the central nervous system. Magnetic resonance imaging of the spinal canal showed a contrast-enhanced swelling on the cervical medulla. Such a case would have warranted the use of antiviral therapy and calls to mind the neurotropic potential of influenza A viruses.

Calbindin is a cytosolic calcium-binding protein abundant in the hair cells of the inner ear and in distinct neurons of the auditory pathway. It is suggested to speed the return of potentially toxic calcium levels to normal. In this study, we show the basic hearing functions and the result of noise trauma from the calbindin null mutant mice generated by gene targeting. Auditory brainstem evoked response and distortion product otoacoustic emissions appear similar as in the control group. A moderate noise-induced trauma produced a similar loss of hair cells in calbindin null mutant mice than in wild-type controls. The result suggests that although calbindin is abundant in hair cells, it is not essential for the main hearing function and it does not provide physiological protection against a moderate noise-induced inner ear trauma in mice.