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Bronchial challenge with flour: early response is dependent on the dose of activated allergen inhaled

¹ Cochin University Hospital, AP-HP-Université Paris 5, Paris, and ² French National Research and Safety Institute (INRS), Vandoeuvre, France

CORRESPONDENCE: D. Choudat, Hôpital Cochin, Service de Pathologie Professionnelle, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. Fax: 33 158412794. E-mail: dominique.choudat@cch.ap-hop-paris.fr

Keywords: occupational asthma, specific bronchial challenge, wheat flour

Received: April 20, 2001
Accepted October 18, 2001

This study was supported by grants from Caisse Nationale d'Assurance Maladie des Travailleurs Salariés and Caisse Régionale d'Assurance Maladie d'Ile-de-France.

Specific bronchial challenges provide information about the relationship between inhaled dose of allergen and change in lung function, but the intermediate pathways remain largely obscure. The aim of this study was to investigate the relationships between the early asthmatic response and 1) the inhaled dose of wheat flour, 2) the concentration of wheat flour, 3) the duration of the exposure, and 4) the deactivation of inhaled allergens and mediators.

Thirty-one patients with occupational asthma to wheat flour were studied. Particle aerosols were generated by a computer-controlled aerosoliser and the results were expressed as the provocative dose causing a 20% fall in forced expiratory volume in one second (FEV₁) (PD₂₀). The cumulative dose (from the beginning of the challenge), the last inhaled dose, and an estimated dose (taking into account exponential deactivation), were calculated.

Twenty patients had high reactivity to flour (reaching a PD₂₀ value). Eleven patients had intermediate reactivity (no measurable PD₂₀ but significantly greater fall in FEV₁ compared with lactose challenge). A better correlation between change in FEV₁ and dose was obtained for the estimated dose than for the cumulative or last inhaled dose.

The bronchial response to wheat flour can be measured by the individual specific hyperreactivity and is expressed by provocative dose of flour. However, deactivation of the allergen and mediators has to be taken into account. This problem can be addressed by using a mathematical model.

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