title: Occupational asthma in female factory worker resulting from exposure to savinase in dishwashing tablets-a case study.
abstract: OBJECTIVE
  Savinase is one of the endopeptidases widely used in washing detergents. Its ability to cause respiratory allergy has been known. Up to now, most cases of occupational asthma (OA) to savinase have been described among workers involved in the manufacture of laundry detergents. We present a case study of 51-year-old female worker of a dishwashing tablets factory, who had been packaging ready-made tablets into foil wrappers for 4 years and developed respiratory symptoms, such as cough, dyspnoea and wheezing.
  
  
  METHODS
  A number of clinical procedures were performed, including the clinical examination, routine laboratory tests, evaluation of total and allergen-specific serum IgE (asIgE) to enzymes, skin prick tests for common allergens, rest spirometry, inhalation methacholine challenge test and a single-blind, placebo-controlled specific inhalation challenge test (SICT) with dishwashing tablets.
  
  
  RESULTS
  Clinical findings and results of routine laboratory tests were within normal limits. Baseline nonspecific bronchial hyperreactivity was revealed. In patient's serum blood we found significantly elevated asIgE to savinase. Decline of FEV1 and PEF in late phase of asthmatic reaction was observed during the specific challenge test. The patient reported chest tightness between 5-12 hours after exposure to dishwashing tablet ingredients. Cytological assessment of an induced sputum revealed increase in the percentage of eosinophils 24 hours after specific challenge in comparison to values noted before the SICT.
  
  
  CONCLUSIONS
  Positive clinical response to the challenge confirmed in objective method tests validated the diagnosis of OA.
authors: Department of Occupational Diseases, Nofer Institute of Occupational Medicine.
authors: Agnieszka
authors: A
authors: Lipińska-Ojrzanowska
authors: Dominika
authors: D
authors: Świerczyńska-Machura
authors: Diana
authors: D
authors: Tymoszuk
authors: Ewa
authors: E
authors: Nowakowska-Świrta
authors: Jolanta
authors: J
authors: Walusiak-Skorupa
mesh_terms: D001249:Asthma / Q000175:diagnosis / Q000209:etiology*; D003902:Detergents / Q000009:adverse effects*; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D008875:Middle Aged; D009784:Occupational Diseases / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects*; D012697:Serine Endopeptidases / Q000009:adverse effects*
chemical_list: D003902:Detergents; D012697:Serine Endopeptidases; C032923:microbial serine proteinases