Occupational allergy caused by carnation (Dianthus caryophyllus),☆☆

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Abstract

Background: Occupational respiratory symptoms caused by decorative flowers are seldom reported in the literature. In our area a large portion of the population works in carnation (Dianthus caryophyllus) winter quarters, and many workers have symptoms of rhinitis and asthma related to exposition. Objective: The purposes of this study were to investigate whether the symptoms induced by carnation were IgE-mediated and to study the possible allergens involved. Methods: A total of 16 subjects employed in indoor carnation cultivation with symptoms during exposition time were studied along with 15 patients with allergic asthma who were not exposed to carnations and 15 healthy carnation workers used as control subjects. Skin prick tests with carnation extract and RASTs were performed. Protein bands were isolated by SDS-PAGE, and afterwards immunoblotting was performed to characterize the extract. Specific nasal provocation and nonspecific bronchial provocation tests were performed for all the asthmatic patients. Diurnal variation in peak expiratory flow was also measured. Results: Skin prick test responses with carnation extract were positive in 15 of the 16 patients and negative in all control subjects. Nasal provocation test responses with carnation extract were positive in 13 of 16 patients. A significant correlation was seen between RAST and nasal provocation results ( P < .01). Immunoblotting of sera from 13 patients showed 2 major IgE-binding fractions of 34 and 35 kd in most of the patients, which could constitute the major allergen. Methacholine PD 20 showed a variable degree of nonspecific bronchial hyperresponsiveness in all asthmatic subjects. Conclusion: Data demonstrate the involvement of carnation in occupational allergy, mediated by an IgE-dependent mechanism. (J Allergy Clin Immunol 1999;104:181-5.)

Section snippets

Patients

A total of 31 asthmatic patients, 16 employed in carnation cultivation with symptoms during exposure and 15 allergic asthmatic patients who were not exposed to carnations (control subjects), were studied. Medication used by patients included inhaled therapy (corticosteroids, inhaled β-agonists, or both on an as-needed basis). None of the patients was in acute respiratory distress at the time of the study or had required treatment with systemic corticosteroids for at least 6 months. Fifteen

RAST

Solid-phase was obtained by coupling the extract solution (2 mg of allergen per disk) to the 6-mm diameter cyanogen bromide–activated paper discs (Bial-Aristegui), according to the method of Ceska and Lundqvist. 6 RAST was performed according to the method of Wide et al 7 with Phadezym Trazer reagents (Kabi Pharmacia), according to the manufacturer’s instructions. Results were expressed as class 0 (<0.35 Phadebas RAST unit [PRU]/mL), class 1 (0.35 to 0.7 PRU/mL), class 2 (0.7 to 3.5 PRU/mL),

SDS-PAGE

SDS-PAGE was performed by the method of Laemmli. 8 Polyacrylamide concentration (12.5%) was used for stacking gels. After electrophoresis, gel proteins were stained with Coomasie Brilliant Blue R-250 or argent solutions, according to needs. It was applied to a parallel protein patron curve with known molecular weights (Pharmacia Biotech): phosphorylase b (94.0 kd), bovine seroalbumin (67.0 kd), ovalbumin (43.0 kd), carbonic anhydrase (30.0 kd), trypsin inhibitor (20.1 kd), and α-lactoalbumin

RESULTS

SPT results with carnation were positive in 15 of the 16 patients and negative in all the asymptomatic carnation workers and nonworker control subjects. The only patient with a negative result had urticaria and no respiratory symptoms. Data of aeroallergen and carnation extract prick tests are presented in Table I .

Serum-specific IgE levels to carnation (RAST) ranged from 0.35 to 4.4 PRU/mL. RAST class 3 was found in 1 serum, although 5 sera demonstrated RAST class 2, 5 sera demonstrated RAST

DISCUSSION

Carnation (D caryophyllus) is an angiosperma dicotiledonea plant, which belongs to the Caryophillacea family, together with Gypsophila paniculata and Saponaria officinalis. At least 250 different species are known to be cultivated indoors, and therefore many workers may be exposed. Allergic disorders induced by ornamental flower exposure are usually manifested by dermatologic symptoms (eczema, urticaria, and contact dermatitis) associated or not with respiratory manifestations, 9, 10, 11 but

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      The clinical relevance of the individual SPT reactions was not specified. Other decorative plants, such as carnation (Dianthus caryophyllus)11 and dried flowers (Limonium tataricum),12 have also been reported as occupational allergens in florists, gardeners, and plant cultivators. Decorative plants have been considered a safe alternative for allergic people, but they too may cause allergy.

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