OCCUPATIONAL ASTHMA CAUSED BY FISH INHALATION

Occupational asthma (OA) due to fish inhalation, confirmed by specific bronchial challenge (SEC), has not been described as yet in medical l iterature, as far as we know. We describe two patients whose asthma wa s induced by occupational exposure to fish and confirmed by serial mea surements of PEFR and SBC. Two fish-processing workers reported asthma symptoms related to their workplace. They were skin tested with fish extracts and their sera assayed for IgE antibodies to various fish spe cies. Nonspecific bronchial reactivity was assessed by methacholine ch allenge. The occupational relationship was confirmed by PEFR monitorin g in working and off-work periods. SBC with fish extracts was carried out to confirm the diagnosis of OA. Skin tests with raw and cooked pla ice, salmon, hake, and tuna in patient 1 and anchovy, sardine, trout, salmon, Atlantic pomfret, and sole in patient 2 were positive. Specifi c IgE serum antibodies were found to salmon in patient 1 and to trout, anchovy, and salmon in patient 2. PEFR measurements differed signific antly (P<0.001) between work and off-work periods for both patients. A bronchial challenge with methacholine was positive in patient 1. SBC with raw hake, salmon, plaice, and tuna extracts in patient 1 and raw salmon extract in patient 2 were all positive with an immediate respon se. SBC with Dermatophagoides pteronyssinus extract was entirely negat ive in both patients. In three asthmatic, non-fish-allergic controls, SBC with tuna, hake, salmon, and plaice were all negative. These resul ts suggest that fish inhalation can elicit IgE-mediated occupational a sthma.