title: Working with argan cake: a new etiology for hypersensitivity pneumonitis.
abstract: BACKGROUND
  Argan is now used worldwide in numerous cosmetic products. Nine workers from a cosmetic factory were examined in our occupational medicine department, following the diagnosis of a case of hypersensitivity pneumonitis (HP) related to handling of argan cakes.
  
  
  METHODS
  Operators were exposed to three forms of argan (crude granulates, powder or liquid) depending on the step of the process. All workers systematically completed standardized questionnaires on occupational and medical history, followed by medical investigations, comprising, in particular, physical examination and chest X-rays, total IgE and a systematic screening for specific serum antibodies directed against the usual microbial agents of domestic and farmer's HP and antigens derived from microbiological culture and extracts of various argan products. Subjects with episodes of flu-like syndrome several hours after handling argan cakes, were submitted to a one-hour challenge to argan cakes followed by physical examination, determination of Carbon Monoxide Diffusing Capacity (DLCO) and chest CT-scan on day 2, and, when necessary, bronchoalveolar lavage on day 4.
  
  
  RESULTS
  Six of the nine workers experienced flu-like symptoms within 8 hours after argan handling. After challenge, two subjects presented a significant decrease of DLCO and alveolitis with mild lymphocytosis, and one presented ground glass opacities. These two patients and another patient presented significant arcs to both granulates and non-sterile powder. No reactivity was observed to sterile argan finished product, antigens derived from argan cultures (various species of Bacillus) and Streptomyces marokkonensis (reported in the literature to contaminate argan roots).
  
  
  CONCLUSIONS
  We report the first evidence of hypersensitivity pneumonitis related to argan powder in two patients. This implies preventive measures to reduce their exposure and clinical survey to diagnose early symptoms. As exposure routes are different and antibodies were observed against argan powder and not the sterile form, consumers using argan-based cosmetics should not be concerned.
authors.affiliation: Université de Lorraine, INGRES, EA 7298, Vandoeuvre lès Nancy, F-54505, France. christophe.paris@inserm.fr.|CHU Nancy, Centre de consultations de pathologies professionnelles, Vandoeuvre lès Nancy, F-54511, France. christophe.paris@inserm.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Paris
authors.affiliation: CHU Toulouse, Service des Maladies Professionnelles et Environnementales, Toulouse, F-31000, France. herin.f@chu-toulouse.fr.|Université de Toulouse, UMR 1027, Toulouse, F-31000, France. herin.f@chu-toulouse.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Herin
authors.affiliation: UMR/CNRS 6249 Chrono Environnement, Université de Franche-Comté, Besançon, F-25030, France. gabriel.reboux@univ-fcomte.fr.|Service de Parasitologie-Mycologie, CHU J. Minjoz, Besançon, F-25030, France. gabriel.reboux@univ-fcomte.fr.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Reboux
authors.affiliation: Université de Lorraine, INGRES, EA 7298, Vandoeuvre lès Nancy, F-54505, France. e.penven@chu-nancy.fr.|CHU Nancy, Centre de consultations de pathologies professionnelles, Vandoeuvre lès Nancy, F-54511, France. e.penven@chu-nancy.fr.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Penven
authors.affiliation: UMR/CNRS 6249 Chrono Environnement, Université de Franche-Comté, Besançon, F-25030, France. coralie.barrera@univ-fcomte.fr.|Service de Parasitologie-Mycologie, CHU J. Minjoz, Besançon, F-25030, France. coralie.barrera@univ-fcomte.fr.
authors.forename: Coralie
authors.initials: C
authors.lastname: Barrera
authors.affiliation: Association Lorraine de Santé en Milieu de Travail, Pulnoy, F-54425, France. cguidat@alsmt.org.
authors.forename: Cécile
authors.initials: C
authors.lastname: Guidat
authors.affiliation: Université de Lorraine, INGRES, EA 7298, Vandoeuvre lès Nancy, F-54505, France. isabelle.thaon@univ-lorraine.fr.|CHU Nancy, Centre de consultations de pathologies professionnelles, Vandoeuvre lès Nancy, F-54511, France. isabelle.thaon@univ-lorraine.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Thaon
mesh_terms: D000328:Adult; D000542:Alveolitis, Extrinsic Allergic / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D003358:Cosmetics / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D009784:Occupational Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011653:Pulmonary Diffusing Capacity; D029632:Sapotaceae / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D003358:Cosmetics