title: Specific Inhalation Challenge in Persulfate Asthma.
abstract: Specific inhalation challenge (SIC) may be considered the 'gold standard' for the diagnosis of occupational asthma due to persulfate salts. The aim of the study was to develop a safe SIC protocol. Between 2003 and 2014, eight patients with suspected occupational asthma due to persulfate salts were examined (7 females, all hair-dressers). SIC was done with a dosimeter and a nebulizer using ammonium persulfate dissolved in phosphate buffer. Until 2009, a four-step-protocol (doses: 0.0004, 0.0045, 0.045, 0.45 mg; cumulative: 0.5 mg) was used, afterwards a six-step-protocol (doses: 0.0004, 0.0018, 0.007, 0.028, 0.113, 0.45 mg; cumulative: 0.6 mg). With each SIC protocol, four subjects were tested. Skin prick tests with ammonium persulfate (20 mg/mL) were performed in all and patch tests in four subjects. In total, four subjects showed a positive SIC, two with each protocol. All subjects showed an isolated late reaction. The greatest decrease of volume in 1 s was 35 % about 3.5 h after the last inhalation (four-step-protocol). Skin prick test with ammonium persulfate was positive in one SIC positive (2 mm wheal) and in two SIC negative patients (3 and 4 mm wheal). All four subjects tested with patch tests showed a positive reaction; three of them were SICpos. We recommend to include patch-testing in the diagnosis of suspected occupational asthma due to persulfate salts. Isolated late asthmatic reactions may occur after SIC. The proposed six-step SIC protocol was safe in this limited number of subjects.
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, D-44789, Bochum, Germany, hagemeyer@ipa-dguv.de.
authors.forename: O
authors.initials: O
authors.lastname: Hagemeyer
authors.forename: E
authors.initials: E
authors.lastname: Marek
authors.forename: V
authors.initials: V
authors.lastname: van Kampen
authors.forename: I
authors.initials: I
authors.lastname: Sander
authors.forename: M
authors.initials: M
authors.lastname: Raulf
authors.forename: R
authors.initials: R
authors.lastname: Merget
authors.forename: T
authors.initials: T
authors.lastname: Brüning
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D001249:Asthma / Q000276:immunology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced*; D013431:Sulfates / Q000009:adverse effects*
chemical_list: D013431:Sulfates