Abstract

BACKGROUND:
Fungal components can cause allergic symptoms either through inhalation, ingestion or contact. Allergic disease from occupational exposure to Boletus edulis (BE) has only seldom been reported.

OBJECTIVES: Report on a female worker who developed respiratory and skin symptoms from occupational exposure to BE in selecting and packing dried mushrooms. She never had symptoms after eating mushrooms.

METHODS:
An environmental study was performed by personal air samplings and settled dust collection. The RAST-inhibition procedure was used to detect BE allergen potency in collected dust. The subject underwent clinical evaluation, spirometry, skin prick-tests, RAST methacoline and specific inhalation challenge with BE extract. A follow-up study was made 2, 4 and 8 months after the first evaluation and after cessation of exposure.

RESULTS:
BE allergens were found in the settled dust. Clinical examination showed eczema on the face and hands. The worker had hyper-eosinophilia, bronchial hyper-responsiveness to methacoline, no allergy to common inhalants and foods, positive prick-test and RAST for BE. The specific inhalation challenge induced broncho-constriction. At follow-up we observed a progressive clinical and functional improvement.

CONCLUSIONS:
Our data show that BE can induce cutaneous and respiratory symptoms from occupational exposure to dried mushroom dusts. The pathogenesis is an IgE-allergy. Our patient had no symptoms from ingestion, which supports the hypothesis that respiratory allergy is due to mushroom antigens that differ from those involved in food-related allergic reactions.

Erratum in: Med Lav. 2006 Jan-Feb;97(1):87
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