title: Inhalation challenge with bovine dander allergens: who needs it?
abstract: OBJECTIVE
  To identify which tests would be useful in selecting patients for a specific inhalation challenge with bovine dander allergens (bSIC).
  
  
  METHODS
  A prospective study.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Thirty-seven dairy farmers with a clinical suspicion of occupational asthma due to bovine allergens.
  
  
  METHODS
  Each patient (n = 27) underwent histamine challenge, mannitol challenge, exhaled nitric oxide (NO) measurement, bovine-specific serum IgE measurement, and skin-prick test (SPT) with bovine allergens prior to undergoing a bSIC.
  
  
  RESULTS
  Eleven patients responded to the inhalation challenge with bovine allergens. The sensitivity and specificity of the tests, based on this response, were 82% and 65%, respectively, for the histamine challenge; 20% and 94%, respectively, for the mannitol challenge; 27% and 77%, respectively, for the NO measurement; 82% and 100%, respectively, for the bovine-specific serum IgE measurement; and 100% and 50%, respectively, for the SPT. Multiple regression analysis revealed that only IgE-mediated sensitivity to bovine allergens, but neither bronchial hyperreactivity nor exhaled NO concentration, contributed significantly to the response.
  
  
  CONCLUSIONS
  Only the SPT with bovine allergens and bovine-specific serum IgE measurements were useful in selecting patients for the bSIC. This challenge should not be performed in SPT-negative subjects. A diagnosis of occupational asthma due to bovine dander allergens could be made without an inhalation challenge test in asthmatic patients with high bovine-specific serum IgE levels. This practice would eliminate the need for the majority of bSICs.
authors.affiliation: Department of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland. heikki.koskela@kuh.fi
authors.forename: Heikki
authors.initials: H
authors.lastname: Koskela
authors.forename: Antti
authors.initials: A
authors.lastname: Taivainen
authors.forename: Hannu
authors.initials: H
authors.lastname: Tukiainen
authors.forename: Hak-Kim
authors.initials: HK
authors.lastname: Chan
mesh_terms: D000328:Adult; D000382:Agricultural Workers' Diseases / Q000175:diagnosis* / Q000276:immunology; D000485:Allergens; D000818:Animals; D001249:Asthma / Q000175:diagnosis* / Q000276:immunology; D001985:Bronchial Provocation Tests; D002417:Cattle; D003612:Dairying; D005260:Female; D006632:Histamine; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008353:Mannitol; D011446:Prospective Studies; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D012882:Skin Tests
chemical_list: D000485:Allergens; D007073:Immunoglobulin E; D008353:Mannitol; D006632:Histamine