A Case of Occupational Asthma and Allergic Rhinitis Due to Pronase

Abstract

Empynase-S(R) is composed of a pronase, a kind of protease derived from Streptomyces griseus. It has been widely used to treat tissue edema in various inflammatory conditions. We experienced a case with occupational asthma and allergic rhinitis after the inhalation of Empynase-S(R) powder in workplace. A 29-year old woman visited our clinic with complaints of cough, sputum, dyspnea, sneezing and rhinorrhea for 5 months. She was a pharmacist and worked in the hospital pharmacy for 17 months. Her symptoms were aggravated during and after grinding tablet into powder. Total eosinophil count and serum total IgE level were elevated. The skin prick test with common inhalant allergens and several suspicious medications showed a positive results to house dust mite (Dermatophagoides pteronyssinus), Empynase-S(R), and pronase. The result of methacholine challenge test was positive (PC20 22.9 mg/mL). Bronchoprovocation test with Empynase-S(R) solution showed an early asthmatic response. The presences of serum specific IgE and IgG4 antibodies to Empynase-S(R) and pronase were identified by ELISA. These findings suggest that pronase powder inhalation could induce occupational asthma and allergic rhinitis through the IgE-mediated mechanism.