Diagnostic validation of specific IgE antibody concentrations, skin prick testing, and challenge tests in chemical workers with symptoms of sensitivity to different anhydrides,☆☆

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Abstract

Background: The diagnostic possibilities of sensitization to various acid anhydrides are limited because of the lack of standardized allergens for the different test systems. This makes the diagnosis of IgE-mediated sensitization caused by occupational exposure difficult. Methods: We prepared conjugates of human serum albumin with phthalic, maleic, trimellitic, and pyromellitic anhydrides to be used for IgE estimation by enzyme-allergosorbent test, skin prick tests, and nasal and bronchial challenge tests. Nine anhydride workers, who complained of various respiratory symptoms, were studied. Results: Of the nine workers, four had immediate-type skin test responses to one or more conjugates. All four subjects had elevated IgE concentrations in addition to two other workers. Three of six nasal challenges and four of nine bronchial challenges resulted in positive responses. All but one of the positive nasal or bronchial test responses were associated with elevated IgE levels. The seven positive challenge test results included five positive skin test responses. On the other hand, in all but two of the subjects with negative challenge test results, no specific IgE could be detected. In these two subjects the negative results were associated with low levels of IgE, and in one, with the absence of asthma. None of the results of tests with unconjugated anhydrides were positive. Conclusions: Anhydrides investigated in this study can induce IgE-mediated hypersensitivity, which can be diagnosed by using the respective human serum albumin in estimation of specific IgE and in skin, nasal, and bronchial challenge tests. Estimation of IgE was demonstrated to be more sensitive than skin prick testing. (J Allergy Clin Immunol 1995;96:489-94.)

Section snippets

Patients

Nine consecutively investigated chemical workers who came to our outpatient department for consultation took part in this study. All of them had been occupationally exposed to dust of different anhydrides in the production of these chemicals for at least 0.7 years (Fig. 1, Table I). A trained occupational physician was responsible for physical examinations and obtaining case histories. Only symptoms that appeared repeatedly in workplaces were considered. Clinical investigations were performed

RESULTS

As shown in Table I, all but one of the nine anhydride workers complained of rhinitis and all but two complained of cough. Of the nine workers, six had both symptoms. Seven subjects reported workplace-related dyspnea, four reported excess phlegm, five reported conjunctivitis, and one reported fever.

DISCUSSION

Our results demonstrate that unconjugated free anhydrides are not suitable for diagnostic testing. This is probably due to rapid hydrolysis of these chemicals in aqueous solutions reacting to the corresponding acids. The pathologic mechanisms clinically relevant in subjects with negative IgE results and symptoms of sensitization have not been clarified. It can be assumed, however, that anhydride dust and, to a minor degree, carboxylic acids formed on hydrolysis behave as irritants in the

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From the Professional Associations’ Institute of Occupational Medicine, Institute at the Ruhr University of Bochum, Germany.

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Reprint requests: Xaver Baur, MD, PhD, BGFA, Buerkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.

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