Occupational Allergy Caused by Inhalation of Pancreatic Extracts in the Medical Personnel and Identification of the Major Allergens

Abstract

Background: Digestive drugs, including pancreatic extracts, have been widely prescribed in this country. There have been several reports of occupational asthma and rhinitis caused by digestive enzymes in workers in pharmaceutical industries; however, there has been no epidemiologic study among the medical personnel. Objective: We evaluated the prevalence of occupational allergy and sensitization rates to digestive drugs in medical personnel and its pathogenic mechanisms. Methods: Eighteen pharmacists, 135 nurses and 123 non atopic normal controls were enrolled. Skin prick tests with 12 common aeroallergens and 5 commonly exposed drugs and its ingredients were performed. Serum specific IgE, IgG1 and IgG4 to alpha-amylase were measured by ELISA. SDS-PAGE followed by IgE and IgG4 immunoblot analysis was performed. Results: Work-related allergy symptoms were observed in 27.8% of pharmacists and 27.4% of nurses. IgE immunoblot analysis demonstrated 3 components which of 19 and 24 kDa were more frequently identified in sera from symptomatic subjects. IgG4 immunoblot analysis demonstrated 2 components of which 19 kDa was more frequently identified in sera from asymptomatic subjects. Conclusion: Digestive drug powders could induce IgE- mediated respiratory allergy symptoms in the medical personnel. Two major allergenic components of alpha-amylase (19, 24 kDa) were identified. Specific IgG4 response to 19 kDa might have a role for preventing the development of work- related allergy symptoms after exposure to alpha-amylase powder.