Vancomycin manufacture, a new cause of OA acting by direct histamine release?

A pharmacetical worker who developed occupational asthma and rhinitis 5 months after starting purification of vancomycin powder. Positive peak flow and history, refused specific challenge. IgE and skin prick testing to vancomycin negative, but strong basophil histamine release using HSA conjugate (negative in controls). Authors suggest that the mechanism is direct histamine release

Agent	Vancomycin
Job	Pharmaceutical manufacturer
Specific IgE	negative
Skin prick test	negative
Non-specific reactivity	methacholine 0.933 mg/ml
Serial Peak Flow	positive  (9.3-62% variablility on workdays, <10% on days off)
BAL	not done
FENO	not done
Basophil histamine release	Significant histamine relase from patients basophils with 1ug/ml HSA conjugate, no release from controls. Authors  suggest mechanism is direct non-allergic histamine release
Specific Challenge	Refused
Follow-up	no information

References

	Choi G-S, Sung J-M, Lee J-W, Ye Y-M, Park H-S, A case of occupational asthma caused by inhalation of vancomycin powder, Allergy, 2009;64:1391-1392,

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