Laukkanen Arja, Ruoppi Pirkko, Remes Sami, Koistinen Tiina, Mäkinen-Kiljunen Soili
Department of Dermatology, Kuopio Unievrsity Hospital, Kuopio 70211, Finland.
Contact Dermatitis. 2007 Aug;57(2):89-93. doi: 10.1111/j.1600-0536.2007.01158.x.
Enzymes are high-molecular-weight proteins and highly sensitizing occupational allergens used widely in industrial processes. Lactase has been described to cause work-related respiratory and conjunctival immunoglobulin (Ig)-E-mediated sensitizations in workers in the pharmaceutical industry. In these previous reports, allergic rhinoconjunctivitis or asthma was confirmed with prick tests but not by challenge tests. Lactase previously has not been described as a cause of immediate or delayed contact skin reaction. Furthermore, there are no previous reports of lactase-specific IgE. We report a case of protein contact dermatitis and allergic rhinoconjunctivitis from occupational exposure to lactase in a pharmaceutical worker. The patient exhibited strong positive responses to lactase in prick tests. In an open application test, lactase elicited whealing, and in patch testing, lactase elicited an eczematous reaction. Serum lactase-specific IgE antibodies were demonstrated in immunospot and radioallergosorbent test assays, and lactase-IgE-binding fractions and their specificities were examined in immunoblot and immunoblot inhibition assays. The chamber challenge test was performed to detect the association between lactase sensitization and rhinoconjunctival symptoms. Our results have confirmed the previous observations that lactase can induce occupational IgE-mediated respiratory and conjunctival sensitizations, but they show that contact skin reactions caused by lactase may also occur.
酶是高分子量蛋白质，也是在工业生产过程中广泛使用的高致敏性职业过敏原。已有报道称，乳糖酶可导致制药行业工人出现与工作相关的呼吸道和结膜免疫球蛋白（Ig）-E介导的致敏反应。在这些先前的报道中，通过点刺试验确诊为过敏性鼻结膜炎或哮喘，但未通过激发试验确诊。此前，乳糖酶尚未被描述为即时或延迟性接触皮肤反应的病因。此外，以前也没有关于乳糖酶特异性IgE的报道。我们报告了一名制药工人因职业接触乳糖酶而发生蛋白质接触性皮炎和过敏性鼻结膜炎的病例。该患者在点刺试验中对乳糖酶表现出强烈的阳性反应。在开放性应用试验中，乳糖酶引发了风团，在斑贴试验中，乳糖酶引发了湿疹反应。在免疫斑点试验和放射变应原吸附试验中检测到血清乳糖酶特异性IgE抗体，并在免疫印迹和免疫印迹抑制试验中检测了乳糖酶-IgE结合组分及其特异性。进行了室内激发试验以检测乳糖酶致敏与鼻结膜症状之间的关联。我们的结果证实了先前的观察结果，即乳糖酶可诱导职业性IgE介导的呼吸道和结膜致敏，但也表明乳糖酶引起的接触皮肤反应也可能发生。
