Occupational asthma in medical personnel caused by inhalation of pancreatic extracts

Abstract

Background and objective : Porcine pancreatic extracts (PPE) are composed of α-amylase, lipase, and protease which are common components of digestives. PPE are known to cause occupational asthma in pharmaceutical workers, but there has been no report of PPE-induced occupational asthma in medical personnel. The aims of this study were to document the rate of sensitization to PPE and the prevalence of PPE-induced occupational asthma in nurses exposed to PPE and to identify possible immunological pathogenic mechanisms. Subjects and Method : A clinical questionnaire on bronchial asthma and allergic rhinitis was distributed among 56 nurses working in the medical ward of Ajou University Hospital. Then, allergy skin prick tests were done with PPE and a battery of eight common inhalant allergens. The determination of specific IgE antibodies to PPE, α-amylase, and lipase was performed by ELISA. The nurses with respiratory symptoms and positive skin tests to PPE underwent methacholine inhalation test and bronchial provocation test with PPE. Results : Of the 56 nurses, five (8.9%) had symptoms suggestive of bronchial asthma, and six (10.7%) had nasal symptoms suggestive of allergic rhinitis. Of these nurses, four (7.1%) had positive results on bronchial provocation test with PPE and proved to have PPE-induced occupational asthma. The prevalences of specific IgE to PPE and α-amylase were significantly higher in patients with positive skin tests (p<0.05). The prevalence of specific IgE to lipase was not significantly different between skin test positive and negative groups (p>0.05). The prevalences of specific IgE to PPE and α-anylase were significantly higher in patients with respiratory symptoms(p<0.05), and four subjects with PPE-induced ashma had high specific IgE antibody to α-amylase, while specific IgE to lipase values were not significantly different between patients with respiratory sypmtoms and those without symptoms (p>0.05). Conclusion : These results support the view that inhalation of α-amylase within PPE powder may induce occupational asthma by IgE mediated reaction in exposed medical personnel.