title: Challenge from methacholine, natural rubber latex, or 4,4-diphenylmethane diisocyanate in workers with suspected sensitization affects exhaled nitric oxide [change in exhaled NO levels after allergen challenges].
abstract: OBJECTIVE
  Nitric oxide (NO) levels in the exhaled air of asthmatic patients have been shown to be increased. This observation has also been reported in workers who are allergic to laboratory animals. To determine if a challenge test with natural rubber latex (NRL) or 4,4'-diphenylmethane diisocyanate (MDI) would also produce an increase of NO exhalation in sensitized patients, we carried out this study.
  
  
  METHODS
  Nine subjects with suspected occupational asthma were exposed to MDI, and 18 took part in a challenge test with gloves powdered with NRL. Nineteen subjects underwent a challenge test with methacholine (MCh). Exhaled NO was measured by a modified chemiluminescence analyzer according to the European Respiratory Society guidelines.
  
  
  RESULTS
  We found that there was a decrease in exhaled NO concentrations 16-18 h after MCh challenge testing and subsequent bronchodilation with salbutamol, in three subjects. Three of nine participants had a significant immediate bronchial obstruction after exposure to MDI, of those three, two had MDI-specific IgE antibodies. After 22 h, their levels of exhaled NO had increased > 10 parts per billion (ppb). Eight of the 18 subjects participating in the NRL challenge test displayed an NO concentration increase of at least 10 ppb after 22 h (seven had NRL-specific IgE antibodies). A significant decrease in the one-second forced expiratory volume (FEV1) was documented in four of those eight participants after NRL challenge.
  
  
  CONCLUSIONS
  There was no clear relationship between bronchial response, substance-specific IgE antibodies and an increase in exhaled NO levels. However, there was a tendency for subjects with substance-specific IgE antibodies and bronchial reaction to develop an increase in exhaled NO concentration. Further studies are needed to determine if analysis of NO from the lower respiratory tract can become a useful non-invasive tool for detecting lower airway inflammatory response even before clinical symptoms occur.
authors.affiliation: Universität Osnabrück Dermatologie-Umweltmedizin-Gesundheitstheorie, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Allmers
authors.forename: Z
authors.initials: Z
authors.lastname: Chen
authors.forename: L
authors.initials: L
authors.lastname: Barbinova
authors.forename: B
authors.initials: B
authors.lastname: Marczynski
authors.forename: V
authors.initials: V
authors.lastname: Kirschmann
authors.forename: X
authors.initials: X
authors.lastname: Baur
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000008:administration & dosage*; D001985:Bronchial Provocation Tests; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D017953:Isocyanates / Q000008:administration & dosage*; D008297:Male; D016210:Methacholine Chloride / Q000008:administration & dosage*; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism*; D009784:Occupational Diseases / Q000378:metabolism*; D012130:Respiratory Hypersensitivity / Q000378:metabolism*; D012408:Rubber / Q000008:administration & dosage*; D012882:Skin Tests; D001559:Benzhydryl Compounds
chemical_list: D000485:Allergens; D017953:Isocyanates; D016210:Methacholine Chloride; D009569:Nitric Oxide; D012408:Rubber; C005969:4,4'-diphenylmethane diisocyanate; D001559:Benzhydryl Compounds