FOOD-INDUCED AND OCCUPATIONAL ASTHMA DUE TO BARLEY FLOUR

Background: Occupational exposure to inhalant allergens may induce ast hma but the presence of asthma after the ingestion of the allergen is rarely reported. Objective: To clarify the clinical relevance of every identified allergen in a patient with respiratory symptoms after expo sure to feeding stuffs and cereal flours in his work environment and a fter ingestion of beverages made of these cereal grains. Methods: Case report. Skin prick tests and serum-specific IgE (CAP-FELA-fluoroenzym eimmunoassay) were used in order to identify specific IgE antibodies. Bronchial provocation tests were performed as an aid in determination of clinical relevance of occupational exposure to the patient's asthma . Results: A 50-year-old man developed bronchial asthma both after exp osure to feeding stuffs and flours and after ingestion of beverages ma de of cereal flours. Allergy to storage mites (Lepidoglyphus destructo r), house dust mites (Dermatophagoides pteronyssinus and farinae), and barley and corn flours were demonstrated by skin testing and serum-sp ecific IgE. Bronchial challenge tests with every allergen showed no re sponse except for an immediate response to barley flour. The most rele vant clinical feature was an immediate asthmatic response developed af ter oral provocation with either barley-made beer or barley flour itse lf which indicates IgE-mediated, food-induced bronchial asthma (sulfit e sensitivity was ruled out). Conclusion: In some particular cases, ba rley flour may induce bronchial asthma through inhalational and oral r outes due to an IgE-mediated mechanism.