Immunologic and functional consequences of chemical (tetrachlorophthalic anhydride)-induced asthma after four years of avoidance of exposure

doi:10.1016/0091-6749(87)90131-X

Journal of Allergy and Clinical Immunology

Volume 80, Issue 2, August 1987, Pages 212-218

https://doi.org/10.1016/0091-6749(87)90131-X Get rights and content

Abstract

Seven patients with occupational asthma caused by a chemical, tetrachlorophthalic anhydride (TCPA), left their work in 1980. They have subsequently avoided TCPA exposure and have been followed until 1985. One patient died in 1981. The six living patients reported continuing symptoms suggestive of asthma, and five who were studied in 1985 demonstrated mild bronchial hyperresponsiveness (histamine concentration provoking a 20% fall in FEV₁ range 2.7 to 12.5 mg/ml). Specific IgE antibody to TCPA conjugated with human serum albumin was measured by a radioallergosorbent test and detected in all patients. After avoidance of exposure, specific IgE fell exponentially with a half-life of 1 year. Specific IgE was still detectable in 1985, and throughout the follow-up period, prick tests with the conjugate elicited immediate skin responses. In 1981 four patients had inhalation tests with TCPA, and specific IgE rose afterward and then fell again.

References (19)

CR Zeiss et al.
Trimellitic anhydride-induced airway syndromes: clinical and immunologic studies
J Allergy Clin Immunol
(1977)
W Howe et al.
Tetrachlorophthalic anhydride asthma: evidence for specific IgE antibody
J Allergy Clin Immunol
(1983)
DI Bernstein et al.
Heterogeneity of specific-IgE responses in workers sensitized to acid anhydride compounds
J Allergy Clin Immunol
(1984)
MD Topping et al.
Specificity of the human IgE response to inhaled acid anhydrides
J Allergy Clin Immunol
(1986)
TAE Platts-Mills et al.
Reduction of bronchial hyperreactivity during prolonged allergen avoidance
Lancet
(1982)
GJ Gleich et al.
Measurement of the absolute levels of IgE antibodies in patients with ragweed hay fever: effect of immunotherapy on seasonal changes and relationship to IgG antibodies
J Allergy Clin Immunol
(1977)
M Ogawa et al.
Biologic properties of IgE myeloma proteins
Am J Med
(1971)
PG Holt et al.
Long-lived IgE- and IgG-secreting cells in rodents manifesting persistent antibody responses
Cell Immunol
(1984)
DW Cockcroft et al.
Standardization of inhalation provocation tests: dose versus concentration of histamine
Chest
(1982)

There are more references available in the full text version of this article.

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¹: From the Department of Occupational Medicine, Brompton Hospital, London.

^∗: From the Occupational Medicine and Hygiene Laboratory, Health and Safety Executive, London.

^∗∗: From the Medical Research Council Tuberculosis and Chest Diseases Unit, Brompton Hospital, London, England.

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Original articleImmunologic and functional consequences of chemical (tetrachlorophthalic anhydride)-induced asthma after four years of avoidance of exposure

Abstract

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Lancet

J Allergy Clin Immunol

Am J Med

Cell Immunol

Chest

Original article
Immunologic and functional consequences of chemical (tetrachlorophthalic anhydride)-induced asthma after four years of avoidance of exposure