Premium
Occupational asthma and allergy to sevoflurane and isoflurane in anaesthetic staff
Author(s) -
Vellore A. D.,
Drought V. J.,
SherwoodJones D.,
Tunnicliffe B.,
Moore V. C.,
Robertson A. S.,
Burge P. S.
Publication year - 2006
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/j.1398-9995.2006.01215.x
Subject(s) - occupational lung disease , medicine , isoflurane , unit (ring theory) , occupational exposure , medical emergency , psychology , anesthesia , mathematics education
(60.6–68.6) and c-globulins with 21% (12.1–17.7). Thyroid-stimulating hormone (TSH) was increased with 4.2 mU/l (0.1–4.0); FT4 and FT3 were normal, but hTg (110 U/ml) and thyroid peroxidase (TPO) (4355 U/ml) antibodies were positive. IgG and C3c circulating immune complexes were increased, with normal IgA and IgM immune complexes. Normal or negative were complete blood count (CBC), C-reactive protein (CRP), C3, antinuclear antibodies (ANA), anti-neutrophil cytoplasmic antibodies (ANCA), hepatitis serology and glucose-6-phosphatedehydrogenase (G-6-PDH). The anti-streptolysin titre was elevated; the patient, however, showed no clinical signs of infection. Urine analysis revealed a microhaematuria and proteinuria, but 24 h urine protein was normal. Chest X-ray and abdominal echography were without pathological findings. We performed an autologous serum skin test (ASST; Greaves test) (2), which was positive; saline showed no reaction (Fig. 1B). A biopsy of a wheal showed features of leucocytoclastic vasculitis (Fig. 1C). The ASST remained over 0.8 cm in size over 2 days. Biopsy revealed a leucocytoclastic vasculitis (Fig. 1D). Based on the clinical and the laboratory findings, the diagnosis of UV associated with PA and Hashimoto’s thyroiditis (HT) was made. We started a therapy with levocetirizine 5 mg/day, rofecoxib 25 mg/day, montelucast 10 mg/ day, levothyroxine 50 lg/day and selenium 50 lg b.i.d. Over a period of 4 weeks our patient responded partially to this treatment. We replaced rofecoxib and montelucast by chloroquine 250 mg/day and after 2 weeks of treatment our patient was completely free of symptoms. After 2 months, chloroquine was given as monotherapy and after a follow-up examination after 6 months, the patient was still asymptomatic. The treatment was well tolerated. Although frequently associated with autoimmune diseases, this is the first reported case of UV associated with PA and HT. A case of chronic angioedema of the tongue associated with PA and HT was previously published (3). Histamine-releasing anti-FcepsilonRIalpha autoantibodies, which are associated with positive skin test responses to autologous sera in patients with chronic idiopathic urticaria (4), have been reported in one patient with UV (5). The ASST has a sensitivity of approximately 70% and a specificity of 80% for detection of patients with autoimmune urticaria (2). Although in vitro tests seem less sensitive than ASST in the detection of patients with histamine-releasing factors in the blood (6), to our knowledge there are no published cases of positive ASST in UV. The findings of a positive ASST with clinical and histological findings of vasculitis have previously not been described. Its occurrence along with circulating immune complexes of IgG and C3c make a pathogenetical role of circulating immune complexes in this patient highly possible. The ASST might be a useful adjunctive test in detecting the underlying pathophysiology in UV; further investigations in this interesting field are required.