Tripathi A, Grammer L C
Ernest S. Bazley Asthma and Allergic Diseases Center, Department of Medicine of Northwestern Memorial Hopsital and Northwestern University Medical School, Chicago, IL, USA.
Ann Allergy Asthma Immunol. 2001 Apr;86(4):425-7. doi: 10.1016/S1081-1206(10)62489-1.
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.
枯草杆菌蛋白酶是一种源于细菌的蛋白水解酶，存在于洗涤剂中。它们是高分子量抗原，与过敏性鼻炎和哮喘有关。
本报告描述了一例因液体清洁剂中的枯草杆菌蛋白酶导致的外源性过敏性肺泡炎病例。
利用临床、放射学和血清学信息进行诊断。
一名53岁女性在使用含有枯草杆菌蛋白酶的清洁剂时出现呼吸道症状。她的症状在工作环境中加剧，离开工作环境后有所改善。计算机断层扫描显示有肺泡和间质浸润，随后出现瘢痕形成。肺功能研究显示为限制性模式，弥散能力降低。支气管肺泡灌洗显示淋巴细胞增多，所有培养结果均为阴性。在患者血清中发现了针对该酶的沉淀抗体。她更换职业后症状有所改善。
患者的临床病史、体格检查、实验室检查和放射学检查结果相结合，支持诊断为由清洁剂中所含酶引起的外源性过敏性肺泡炎。
