title: Deer ked-induced occupational allergic rhinoconjunctivitis.
abstract: BACKGROUND
  Deer keds (elk fly) have not previously been described as a cause of respiratory or conjunctival sensitization.
  
  
  OBJECTIVE
  To report a case of IgE-mediated allergic rhinoconjunctivitis from occupational exposure to deer ked.
  
  
  METHODS
  Skin prick testing (SPT) was performed with pollens, animal danders, mites, molds, and deer ked. The serum deer ked-specific IgE level was examined in ImmunoSpot and radioallergosorbent test assays, and deer ked IgE-binding fractions and their specificities were examined in immunoblot and immunoblot inhibition assays. Nasal provocation testing (NPT) and conjunctival provocation testing (CPT) were performed to detect the association between deer ked sensitization and rhinoconjunctival symptoms. Both SPT and NPT were performed with deer ked whole-body extract, whereas CPT was performed with deer ked wing.
  
  
  RESULTS
  The results of SPT, NPT, and CPT were positive for deer ked. In laboratory tests, serum deer ked-specific IgE antibodies were demonstrated in radioallergosorbent test and ImmunoSpot assays. In immunoblot, IgE-binding bands were demonstrated at 17, 33, 70, and 85 kDa, which were clearly inhibited with deer ked extract but not with the control extract.
  
  
  CONCLUSIONS
  Occupational IgE-mediated rhinoconjunctival allergy to deer ked was confirmed in this patient.
authors.affiliation: Department of Dermatology, Kuopio University Hospital, Kuopio, Finland. arja.laukkanen@kuh.fi
authors.forename: Arja
authors.initials: A
authors.lastname: Laukkanen
authors.forename: Pirkko
authors.initials: P
authors.lastname: Ruoppi
authors.forename: Soili
authors.initials: S
authors.lastname: Mäkinen-Kiljunen
mesh_terms: D000328:Adult; D000485:Allergens / Q000009:adverse effects / Q000032:analysis; D000818:Animals; D003233:Conjunctivitis, Allergic / Q000097:blood / Q000209:etiology* / Q000276:immunology; D004175:Diptera / Q000276:immunology; D006801:Humans; D007106:Immune Sera; D007073:Immunoglobulin E / Q000032:analysis / Q000276:immunology; D019570:Inhalation Exposure / Q000009:adverse effects; D007299:Insect Bites and Stings / Q000209:etiology* / Q000276:immunology; D008297:Male; D009299:Nasal Provocation Tests; D016273:Occupational Exposure / Q000009:adverse effects*; D012221:Rhinitis, Allergic, Perennial / Q000097:blood / Q000209:etiology* / Q000276:immunology; D012882:Skin Tests; D013045:Species Specificity
chemical_list: D000485:Allergens; D007106:Immune Sera; D007073:Immunoglobulin E