Extrinsic allergic alveolitis from a proteolytic enzyme

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
A Tripathi, L C Grammer

Abstract

Subtilisins are proteolytic enzymes of bacterial origin found in detergents. They are high-molecular-weight antigens and have been implicated in allergic rhinitis and asthma. This report describes a case of extrinsic allergic alveolitis due to subtilisins in a liquid cleaner. Clinical, radiologic, and serologic information were used to make the diagnosis. A 53-year-old woman developed respiratory symptoms while working with a cleaner containing subtilisins. Her symptoms intensified in the work environment and improved away from work. A computed tomography scan demonstrated alveolar and interstitial infiltrates with subsequent scarring. A pulmonary function study revealed a restrictive pattern with diminished diffusion capacity. Bronchoalveolar lavage showed lymphocytosis and all cultures were negative. Precipitating antibodies to the enzyme were found in the patient's serum. Her symptoms improved once she changed her occupation. The combination of the patient's clinical history, physical, laboratory, and radiologic findings support the diagnosis of extrinsic allergic alveolitis from the enzyme contained in the cleaner.

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Citations

Jun 23, 2006·Archives of Environmental Health·Massod M A BoojarManochehr M A Boojar
Feb 25, 2010·World Journal of Gastroenterology : WJG·Ying FangYou-Ming Li
Dec 18, 2002·Critical Reviews in Clinical Laboratory Sciences·Eunhee S Yi
Feb 3, 2016·Respiratory Medicine·M L Millerick-MayK D Rosenman
Oct 8, 2011·Immunology and Allergy Clinics of North America·Michael C Zacharisen, Jordan N Fink
Sep 29, 2005·Psychological Bulletin·Karl GrammerJohn T Manning

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