Occupational Asthma Reference

Boulet L-P, Laberge F, Occupational asthma to fish, Occup Environ Med, 2014;71:804,doi:10.1136/oemed-2014-102439

Keywords: Canada, cook, fish, challenge, br, prick test, case report, Yellowfin sole

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Allergic responses to a variety of seafood have been described, including fish. We report the evaluation of a 31-year-old worker who developed occupational asthma following exposure to sole fish (Yellowfin sole). She had been working in a restaurant’s kitchen, cooking different types of products including fish, most often sole. In the last 3 years, this worker had developed erythema and pruritus of the hands and forearms while she was manipulating fishes such as sole, she had increasing symptoms of dyspnoea, chest tightness and wheezing when she was exposed to cooking fumes from sole fish. She also reported symptoms suggestive of localised angioedema developing when she was eating fish. She had no nocturnal respiratory symptoms. She had smoked about 10 cigarettes per day since the age of 18.
Allergen skin prick tests were positive to animals, house dust mites and pollens, in addition to sole fish extract. She had mild-to-moderate airway obstruction, with a FEV1/FVC of 1.89 L/3.33 L (67 and 95% of predicted value). PC20 methacholine was 0.67 mg/mL. She had a specific bronchoprovocation test with sole fish extract.The control day showed no changes in her baseline expiratory flows but when she was exposed to fish extract at a 1/126 dilution for 30 s, she developed a cough, chest tightness and dyspnoea, associated with a 30% fall in FEV1 compared to baseline, with a slow recovery over a period of 2 h. No late response was observed. The day after challenge, FEV1 was 1.95 L (68%) and PC20 methacholine was 0.38 mg/mL. Induced sputum eosinophil count was 3% of 10.8×106 cells/g. No increase in induced sputum eosinophils was noted after the challenge.

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