Grain-induced asthma is a frequent occupational allergic disease mainly caused by inhalation of cereal flour or powder. The main professions affected are bakers, confectioners, pastry factory workers, millers, farmers, and cereal handlers. This disorder is usually due to an IgE-mediated allergic response to inhalation of cereal flour proteins. The major causative allergens of grain-related asthma are proteins derived from wheat, rye and barley flour, although baking additives, such as fungal alpha-amylase are also important. This review deals with the current diagnosis and treatment of grain-induced asthma, emphasizing the role of cereal allergens as molecular tools to enhance diagnosis and management of this disorder. Asthma-like symptoms caused by endotoxin exposure among grain workers are beyond the scope of this review. Progress is being made in the characterization of grain and bakery allergens, particularly cereal-derived allergens, as well as in the standardization of allergy tests. Salt-soluble proteins (albumins plus globulins), particularly members of the alpha-amylase/trypsin inhibitor family, thioredoxins, peroxidase, lipid transfer protein and other soluble enzymes show the strongest IgE reactivities in wheat flour. In addition, prolamins (not extractable by salt solutions) have also been claimed as potential allergens. However, the large variability of IgE-binding patterns of cereal proteins among patients with grain-induced asthma, together with the great differences in the concentrations of potential allergens observed in commercial cereal extracts used for diagnosis, highlight the necessity to standardize and improve the diagnostic tools. Removal from exposure to the offending agents is the cornerstone of the management of grain-induced asthma. The availability of purified allergens should be very helpful for a more refined diagnosis, and new immunomodulatory treatments, including allergen immunotherapy and biological drugs, should aid in the management of patients with this disorder.
Allergens ; alpha-Amylases ; Asthma ; Candy ; Carrier Proteins ; Cereals ; Desensitization, Immunologic ; Flour ; Hordeum ; Humans ; Hypersensitivity ; Immunoglobulin E ; Inhalation ; Peroxidase ; Prolamins ; Proteins ; Secale cereale ; Thioredoxins ; Triticum

Grain-induced asthma is a frequent occupational allergic disease mainly caused by inhalation of cereal flour or powder. The main professions affected are bakers, confectioners, pastry factory workers, millers, farmers, and cereal handlers. This disorder is usually due to an IgE-mediated allergic response to inhalation of cereal flour proteins. The major causative allergens of grain-related asthma are proteins derived from wheat, rye and barley flour, although baking additives, such as fungal alpha-amylase are also important. This review deals with the current diagnosis and treatment of grain-induced asthma, emphasizing the role of cereal allergens as molecular tools to enhance diagnosis and management of this disorder. Asthma-like symptoms caused by endotoxin exposure among grain workers are beyond the scope of this review. Progress is being made in the characterization of grain and bakery allergens, particularly cereal-derived allergens, as well as in the standardization of allergy tests. Salt-soluble proteins (albumins plus globulins), particularly members of the alpha-amylase/trypsin inhibitor family, thioredoxins, peroxidase, lipid transfer protein and other soluble enzymes show the strongest IgE reactivities in wheat flour. In addition, prolamins (not extractable by salt solutions) have also been claimed as potential allergens. However, the large variability of IgE-binding patterns of cereal proteins among patients with grain-induced asthma, together with the great differences in the concentrations of potential allergens observed in commercial cereal extracts used for diagnosis, highlight the necessity to standardize and improve the diagnostic tools. Removal from exposure to the offending agents is the cornerstone of the management of grain-induced asthma. The availability of purified allergens should be very helpful for a more refined diagnosis, and new immunomodulatory treatments, including allergen immunotherapy and biological drugs, should aid in the management of patients with this disorder.
Allergens ; alpha-Amylases ; Asthma ; Candy ; Carrier Proteins ; Cereals ; Desensitization, Immunologic ; Flour ; Hordeum ; Humans ; Hypersensitivity ; Immunoglobulin E ; Inhalation ; Peroxidase ; Prolamins ; Proteins ; Secale cereale ; Thioredoxins ; Triticum

This study was carried out to manifest risk factors related grain dust induced asthma, especially allergic and immunologic factors. Six grain workers first diagnosed as grain dust induced asthma by specific antigen bronchial asthma challenge test (cases) and 37 grain workers showed negative finding (controls) in the same firm were selected. Questionnaire survey for respiratory symptoms, interview, physical examination, PFT, methacholine bronchial hyperresponsiveness, specific challenge tests and skin prick test for four grains (grain, corn, rye and seed dust) were conducted. To evaluate the role of specific antibodies to grain dust, we detected serum specific IgE and IgG antibodies by ELISA in 43 employees. The results were summarized as follows : 1. Compared with the group having no respiratory symptoms, odds ratio of grain dust induced asthma with respiratory symptoms was 3.04 (95% CI 0.32-28.80). 2. Compared with the group having no ventilatory impairment, odds ratio of grain dust induced asthma with ventilatory impairment was 0.54 (95% CI 0.06-5.21). 3. Compared with the group showed negative skin test for general respirable antigen, odds ratio of grain dust induced asthma with atopy was 8.02 (95% CI 0.42-153.25). 4. Compared with the group showed negative finding on specific allergic skin test, odds ratio of grain dust induced asthma with positive finding was 5.88 (95% CI 0.63-55.38). 5. In immunologic test, compared with the group not increased total IgE(<160 IU/ml), odds ratio of grain dust induced asthma with increased group (> or = 160 IU/ml) was 4.78 (95% CI 0.50-44.57). 6. Compared with the group showed negative finding on specific IgE antibody, odds ratio of grain dust induced asthma with positive finding was 2.63 (95% CI 0.43-16.16). 7. Compared with the group showed normal finding on nonspecific (methacholine) bronchial hyperresponsiveness, odds ratio of grain dust induced asthma with positive finding was 76.82(95% CI 3.37 - 1566.34). Statistically significant odds ratio were fecund for specific skin test with grain, total IgE and nonspecific (methacholine) bronchial hyperreponsiveness.
Antibodies ; Asthma ; Asthma, Occupational* ; Cereals* ; Dust ; Enzyme-Linked Immunosorbent Assay ; Immunoglobulin E ; Immunoglobulin G ; Immunologic Factors ; Immunologic Tests ; Methacholine Chloride ; Odds Ratio ; Physical Examination ; Questionnaires ; Risk Factors* ; Secale cereale ; Skin ; Skin Tests ; Zea mays

This study was carried out to manifest risk factors related grain dust induced asthma, especially allergic and immunologic factors. Six grain workers first diagnosed as grain dust induced asthma by specific antigen bronchial asthma challenge test (cases) and 37 grain workers showed negative finding (controls) in the same firm were selected. Questionnaire survey for respiratory symptoms, interview, physical examination, PFT, methacholine bronchial hyperresponsiveness, specific challenge tests and skin prick test for four grains (grain, corn, rye and seed dust) were conducted. To evaluate the role of specific antibodies to grain dust, we detected serum specific IgE and IgG antibodies by ELISA in 43 employees. The results were summarized as follows : 1. Compared with the group having no respiratory symptoms, odds ratio of grain dust induced asthma with respiratory symptoms was 3.04 (95% CI 0.32-28.80). 2. Compared with the group having no ventilatory impairment, odds ratio of grain dust induced asthma with ventilatory impairment was 0.54 (95% CI 0.06-5.21). 3. Compared with the group showed negative skin test for general respirable antigen, odds ratio of grain dust induced asthma with atopy was 8.02 (95% CI 0.42-153.25). 4. Compared with the group showed negative finding on specific allergic skin test, odds ratio of grain dust induced asthma with positive finding was 5.88 (95% CI 0.63-55.38). 5. In immunologic test, compared with the group not increased total IgE(<160 IU/ml), odds ratio of grain dust induced asthma with increased group (> or = 160 IU/ml) was 4.78 (95% CI 0.50-44.57). 6. Compared with the group showed negative finding on specific IgE antibody, odds ratio of grain dust induced asthma with positive finding was 2.63 (95% CI 0.43-16.16). 7. Compared with the group showed normal finding on nonspecific (methacholine) bronchial hyperresponsiveness, odds ratio of grain dust induced asthma with positive finding was 76.82(95% CI 3.37 - 1566.34). Statistically significant odds ratio were fecund for specific skin test with grain, total IgE and nonspecific (methacholine) bronchial hyperreponsiveness.
Antibodies ; Asthma ; Asthma, Occupational* ; Cereals* ; Dust ; Enzyme-Linked Immunosorbent Assay ; Immunoglobulin E ; Immunoglobulin G ; Immunologic Factors ; Immunologic Tests ; Methacholine Chloride ; Odds Ratio ; Physical Examination ; Questionnaires ; Risk Factors* ; Secale cereale ; Skin ; Skin Tests ; Zea mays

BACKGROUND AND OBJECTIVES: The incidence of allergic rhinitis and the kinds of offending allergens in our environment are varying as the way of life changes with urbanization and industrialization. Therefore, knowledge of the relationship between allergic rhinitis and the offending allergen is crucial for therapeutic judgment. The purpose of this study was to find out the incidence and distribution of offending allergens and investigate the prevalence of multiple sensitization on patients with allergic rhinitis. MATERIALS AND METHOD: Allergic skin test and multiple allergosorbent chemiluminescent assay (MAST-CLA) was performed for 1, 705 allergic rhinitis patients from Jan. 1998 to Dec. 2001 at the allergy clinic, Kyung Hee university Hospital. and a retrospective study was done by reviewing the result. RESULTS: Common offending allergens were Dermatopgagoides farinae (D. farinae), Dermatophagoides pteronyssinus (D. pteronyssinus), various pollens, dog hair, cockroach, and cat hair. Common offending seasonal allergens were ragweed, mugwort, rye, timothy grass, and Bermuda grass. The most common combination of allergens was mites with animal danders. Nineteen point three percent of the patients were sensitized to both perennial and seasonal type of allergens. Thirty point eight percent of patients with PAR (perennial allergic rhinitis) and 66.7% of patients with SAR (seasonal allergic rhinitis) were sensitized to multiple allergen. The prevalence of mixed sensitization to both perennial and seasonal allergen is 19.3% in allergic rhinitis. CONCLUSION: The overall prevalence of multiple sensitization in allergic rhinitis is 52.7%.
Allergens* ; Ambrosia ; Animals ; Artemisia ; Cats ; Climacteric ; Cockroaches ; Cynodon ; Dander ; Dermatophagoides pteronyssinus ; Dogs ; Hair ; Humans ; Hypersensitivity ; Incidence ; Judgment ; Luminescent Measurements ; Mites ; Phleum ; Pollen ; Prevalence* ; Retrospective Studies ; Rhinitis* ; Seasons ; Secale cereale ; Skin Tests ; Statistics as Topic* ; Urbanization ; Industrial Development

The 16 cases of patient with Hodgkin's disease admitted to Department of Pediatrics. Yonsei Cancer Center, Collage of Medicine, Yonsei University during 15 years from January 1975 to December 1989 were reviewed on the basis of clinical charicteristics, treatment and survival rate. The results were summerized as follows. 1) The mean age of patients was 7.6 4.1(range 2~15 years of age). 2) The clinical symptoms and signs were fever (50%), cervical lymphoadenpathy (44%), weight loss(25%), night sweat sweat(19%), hepatomegaly (13%) in order. 3) The stage by Ann Arbor classification revealed Stage I (19%), Stage II (37%), Stage III (19%), stage IV (25%). 4) The histologic subtype of the 14 cases confirmed by Rye Classification revealed that mixed cellularity type (57%) was the most common and lymphocyte predominant type (28%), nodular 5) The seven patients were treated by combind modality therapy, and the six patients by chemotherapy only and the three patients by radiotherapy only. 6) Overall 5 year survival rate was 69% in all patients, and 100% in Stage I, II, 67% in Stage III, but the patients of Stage IV were all died within 7 months.
Classification ; Drug Therapy ; Fever ; Hepatomegaly ; Hodgkin Disease* ; Humans ; Lymphocytes ; Pediatrics ; Radiotherapy ; Secale ; Survival Rate ; Sweat

Low glycemic index (GI) foods have been reported to be very important in the control of blood glucose levels in diseases such as diabetes mellitus and obesity, which are becoming more prevalent in Korea. Bread consumption at breakfast and as a snack is also on the rise. To provide low GI alternatives, breads supplemented with dietary fibersfructooligosaccharide (FOS), ground whole rye, and 2 types of resistance starch (RS2 and RS4)-were developed. The GIs for these breads were evaluated with 13 healthy college students (M6, F7) and sensory tests were done. Four kinds of breads were made through the modification of a basic recipe for white bread (the control, B) as follows: for Bf, the entire amount of sugar was replaced with FOS. For Ryef, 50% of the white wheat flower was replaced with roughly ground wholerye (20 mesh: 12-20 mesh = 1 : 3) in addition to replacing sugar with FOS. For RS2f and RS4f, 20% of the white wheat flower was replaced with RS2 or RS4, in addition to replacing sugar with FOS. The overall preference score of Bf was similar to that of B, while those of Ryef, RS2f and RS4f were lower than that of B, but showed the acceptable degree of the overall preference. The glycemic indices of Ryef and RS2f were 46.1 and 45.9 respectively, which were significantly lower than the GI of B, 67.8. The GIs of Bf and RS4f were, however, 66.7 and 80.5 respectively, showing no significant difference compared to B. The glycemic loads for a 30 g serving were 9.5, 5.9, 6.2, 11.0 and 9.0 for B, Bf, Ryef, RS2f and RS4f, respectively. In conclusion, addition of RS2 or roughly ground whole rye to the dough formula significantly lowered the GI. Since the preferences shown for those two breads were acceptable, they may be recommended as a substitute for white bread for persons who need blood glucose management. More studies on the bread making process are required to improve preference and acceptance. Although GI lowering effects for F and RS4 were not found in this study, further studies are needed to verify their effects.
Blood Glucose ; Bread* ; Breakfast ; Edible Grain* ; Diabetes Mellitus ; Flowers ; Glycemic Index* ; Humans ; Korea ; Obesity ; Secale* ; Snacks ; Starch* ; Triticum

BACKGROUND AND OBJECTIVE: The Allergodip(R) multi-allergen screening test is a simple method for measuring serum-specific IgE to common inhalant allergens simultaneously. The dipstick contains nine separate allergen pads including D. pteronyssinus, Alternaria, cat epithelium, dog epithelium, English plantain, mugwort, birch, rye and six-grass mixture pollen extracts, as well as positive and negative controls. This study was performed in order to evaluate sensitivity and specificity of this test in comparison to skin prick test. MATERIALS AND METHOD: We compared the results obtained by skin prick test (PT) to those obtained by Allergodip(R) test (AT) in 30 patients with various allergic diseases. The skin reactivity was presented as allergen to histamine ratio (A/H) and results of the AT test were assessed visually and classified into Allergodip(R) class 0-4. RESULTS: Compared with PT, results of AT gave a sensitivity of 55.3% and a specificity of 93.8% when the A/H > OR = 3 was considered a positive response for PT. The agreement rate between positive PT and positive AT to each antigen was 82.6% in D. pteronyssinus, 82.9% in Alternaria, 71.1% in dog epithelium, 57.2% in mugwort pollen, 57.2% in birch pollen, 49.9% in grasses mixture pollen, 23.6% in cat epithelium and 6.7% in rye grass pollen, respectively. Significant correlations were noted between PT and AT classes in D. pteronyssinus, Alternaria, dog epithelium, mugwort pollen, birch pollen, and in grasses mixture pollen (p < 0.05, respectively), but not in cat epithelium or rye grass pollen. CONCLUSION: We concluded that Allergodip(R) test is useful in screening serum-specific IgE antibodies against multiple allergens at one time.
Allergens ; Alternaria ; Animals ; Antibodies ; Artemisia ; Betula ; Cats ; Dogs ; Epithelium ; Histamine ; Humans ; Hypersensitivity* ; Immunoglobulin E ; Lolium ; Mass Screening* ; Plantago ; Poaceae ; Pollen ; Secale ; Sensitivity and Specificity ; Skin

BACKGROUND AND OBJECTIVE: The selection of allergen panels is a prerequisite to effectively test for innumerable allergens scattered throughout the environment. However, the selection of the pre-existing panel has been vague and contains some allergens that have not been verified as being common in Korea. This study was aimed to produce allergen panels in Korea. METHODS: For 12 months in 1996, sera were tested by the chemiluminescent assay of Multiple allergen simultaneous test (MAST-CLA: Immunosystems, Mountain view, U.S.A.). A total of 2, 467 specimens that either tested positive or were negative but had high total IgE level were pooled together. The pooled ser a were assayed for 60 allergens supplied by Dexall Acti Tip System (Dexall biomedical Labs. Inc., Gaithersburg, U.S.A.), a recently developed enzyme immunoassay. According to the Allerg Ens Unit (Allergen Unit:AU), 12 of the most frequently encountered and 6 of the leaot frequent allergens with reactions between classes 3 and trace were selected. RESULTS: The 12 most frequently encountered allergens were : Dermatophagoides pteronyssinus, Dermatophagoides farinae, house dust, timothy grass, perennial rye, mugwort, birch, oak, hazel nut, common ragweed, alder and dog dander. The 6 least frequently encountered were : wheat, egg-white, cat epithelium, milk, cockroach and shrimp. CONCLUSION: The 12 allergens we chose proposed to be the minimally required panel of frequently encountered allergens in allergy testing. We conclude that the 12 most frequent allergens should be tested with the total IgE level as a major panel (panel-M) and that the 6 least frequently encountered allergens may be tested separately when needed, as a minor panel (panel-m).
Allergens ; Alnus ; Ambrosia ; Animals ; Artemisia ; Betula ; Cats ; Cockroaches ; Dander ; Dermatophagoides pteronyssinus ; Dogs ; Dust ; Epithelium ; Hypersensitivity ; Immunoenzyme Techniques ; Immunoglobulin E ; Korea ; Luminescent Measurements ; Milk ; Nuts ; Phleum ; Secale ; Triticum

BACKGROUND: Baker's asthma is a common occupational respiratory disease and its prevalence rate varies from 15% to 30% of the workers in foreign countries. It has been reported mainly in bakers and millers due to sensitization to wheat, rye, storage mites, and several enzymes etc. But, the main allergen of baker's asthma is wheat. As there is an increase of consumption of food made of wheat due to westernized life style, it is expected that the prevalence of baker's asthma is increasing or already increased. But, there has been no study to investigate the prevalence of baker's asthma in this country. OBJECTIVE: The purpose of this study was to investigate the prevalence of baker's asthma due to wheat sensitization in baking factory workers. METHOD: A total of 147 bakers (age 32.6+/-8.2 years, male 63%) were enrolled in this study. They responded to a modified ISSAC questionnaire and underwent methacholine bronchial challenge test, and skin prick test with common inhalant allergens and work-related allergens including commercial wheat antigen, bread flour, and cake flour antigen prepared in our laboratory. And specific bronchial challenge test with wheat extract was performed to volunteers. RESULTS: The atopic prevalence based on skin prick test was 43% (63/147), and wheat sensitization rate (including commercial wheat, bread flour and cake flour antigen) was 15% (22/147). The risk factors for wheat sensitization were atopy, long duration occupied in baking process, and current or past work history in mixing and/or measuring part where wheat flour exposure was relatively high (p<0.05). Wheat sensitization was highly associated with bronchial hyperresponsiveness, work related symptoms such as asthma, rhinitis, conjunctivitis, and dermatitis (p<0.05) respectively. The prevalence of current asthma based on questionnaire and methacholine bronchial challenge test was 8% (11/147 bakers). Of these, 8 bakers were sensitized to wheat antigen, and all of them except one baker complained of work-related symptoms. These seven bakers were highly suspected of baker's asthma due to wheat sensitization. Two of these seven bakers showed early asthmatic response on specific broncho-provocation test. CONCLUSION: Wheat sensitization rate was 15%, The prevalence of baker's asthma due to wheat sensitization was 5% in baking factory workers and it's risk factors were atopy, long duration occupied in baking process, and current or past work history in mixing and/or measuring part of baking process.
Acaridae ; Allergens ; Asthma* ; Bread ; Bronchial Provocation Tests ; Conjunctivitis ; Dermatitis ; Flour ; Humans ; Life Style ; Male ; Methacholine Chloride ; Prevalence* ; Rhinitis ; Risk Factors ; Secale ; Skin ; Triticum* ; Volunteers ; Surveys and Questionnaires