Reference

Koskela H, Taivainen A, Tukiainen H et al, Inhalation challenge with bovine dander allergens: who needs it?, Chest, 2003;124:383-391,

BOHRF Original Authors' Main Conclusions

The original authors' main conclusions are taken from Abstract, Results and Discussion. They are decided upon by the authors of the BOHRF occupational asthma guidelines and form part of the guidelines.

37 dairy farmers with suspected occupational asthma due to bovine allergens were studied to identify which tests would be useful in selecting patients for a specific inhalation challenge with bovine dander allergens. The sensitivity and specificity of bovine allergen IgE was studied. It appeared that the skin prick allergen was a homemade one and the IgE assay was a Pharmacia unicap. The specific IgE assay had a sensitivity of 9/11 and a specificity of 100%. The skin prick test (at more than 3 mm) had a sensitivity of 11/11 and a specificity of 13/26. There was no additional benefit from measuring the histamine PC20 or exhaled NO compared with specific challenge test. The clinical history had poor predictive value (specificity 13/36). Authors did however comment that a positive history and a positive specific IgE was sufficient to make the diagnosis.

BOHRF Associated Evidence Statements

The BOHRF occupational asthma guidelines state that this reference is associated with the following evidence statements

Free histories taken by experts have high sensitivity, but their specificity may be lower.

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A large number of concordant studies from different centres using different methodologies demonstrated that increased non-specific reactivity is often found in workers with occupational asthma. There are however many reports of normal methacholine or histamine reactivity within 24 hours of exposure in workers with confirmed occupational asthma.

Non Bohrf Information

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