[Occupational allergic IgE-mediated disease from Boletus edulis: case report].
BACKGROUND
Fungal components can cause allergic symptoms either through inhalation, ingestion or contact. Allergic disease from occupational exposure to Boletus edulis (BE) has only seldom been reported.


OBJECTIVE
Report on a female worker who developed respiratory and skin symptoms from occupational exposure to BE in selecting and packing dried mushrooms. She never had symptoms after eating mushrooms.


METHODS
An environmental study was performed by personal air samplings and settled dust collection. The RAST-inhibition procedure was used to detect BE allergen potency in collected dust. The subject underwent clinical evaluation, spirometry, skin prick-tests, RAST methacoline and specific inhalation challenge with BE extract. A follow-up study was made 2, 4 and 8 months after the first evaluation and after cessation of exposure.


RESULTS
BE allergens were found in the settled dust. Clinical examination showed eczema on the face and hands. The worker had hyper-eosinophilia, bronchial hyper-responsiveness to methacoline, no allergy to common inhalants and foods, positive prick-test and RAST for BE. The specific inhalation challenge induced broncho-constriction. At follow-up we observed a progressive clinical and functional improvement.


CONCLUSIONS
Our data show that BE can induce cutaneous and respiratory symptoms from occupational exposure to dried mushroom dusts. The pathogenesis is an IgE-allergy. Our patient had no symptoms from ingestion, which supports the hypothesis that respiratory allergy is due to mushroom antigens that differ from those involved in food-related allergic reactions.
Baruffini
Adriana
A
Azienda ospedaliera Ospedale Lecco, U.O. Medicina del Lavoro. a.baruffini@ospedale.lecco.it
Pisati
G
G
Russello
Marina
M
Falagiani
P
P
D000328:Adult; D000946:Antigens, Fungal / Q000276:immunology*; D001249:Asthma / Q000175:diagnosis / Q000276:immunology*; D001487:Basidiomycota / Q000276:immunology*; D016535:Bronchial Hyperreactivity; D003877:Dermatitis, Contact / Q000175:diagnosis / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology*; D009784:Occupational Diseases / Q000175:diagnosis / Q000276:immunology*; D016273:Occupational Exposure / Q000009:adverse effects*; D011852:Radioallergosorbent Test; D012307:Risk Factors; D012882:Skin Tests; D013147:Spirometry; D013997:Time Factors
D000946:Antigens, Fungal; D007073:Immunoglobulin E