Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Department Allergology/Immunology, Ruhr University Bochum (IPA), Bochum, Germany.
Int Arch Allergy Immunol. 2012;157(2):202-8. doi: 10.1159/000324953. Epub 2011 Oct 7.
Allergic reactions to wood dust allergens are rare, and only few in vitro diagnostic tools and information about relevant allergens are available. To differentiate between protein-based allergy and probably clinically silent glycogenic sensitization, it is helpful to characterize the relevant protein allergens and specify IgE binding. The current case report deals with the occupational softwood allergy of a carpenter exposed to different wood dusts. Skin tests and IgE tests against wood were performed with specifically tailored ImmunoCAPs and cross-reactive carbohydrate determinants. Potential allergens were identified by IgE blots and tandem mass spectrometry. The clinical relevance was verified by challenge tests. Specific IgE to softwood (spruce, pine and larch wood), beech wood, natural rubber latex (NRL) and horseradish peroxidase (HRP) were detected. Allergens in spruce wood, the dominant allergen source, were identified as peroxidases. Softwood were the strongest inhibitors. HRP reduced IgE binding to softwood to <50%, indicating predominantly proteinogenic epitopes, whereas IgE binding to NRL and beech wood was reduced to >50% by HRP, indicating predominantly glycogenic IgE epitopes. Skin and challenge tests underlined that softwoods were the source of sensitization. For the polysensitized patient, a clinically relevant softwood allergy was diagnosed, not only by challenge tests but also with specifically tailored in vitro tools.
对木尘过敏原的过敏反应很少见，并且仅有少数体外诊断工具和有关过敏原的信息可用。为了区分基于蛋白质的过敏反应和可能临床上无明显表现的糖基化致敏，表征相关的蛋白质过敏原并确定 IgE 结合是有帮助的。本病例报告涉及一名木匠接触不同木尘时的职业性软木过敏。使用专门定制的 ImmunoCAP 和交叉反应性碳水化合物决定簇进行了针对木材的皮肤测试和 IgE 测试。通过 IgE 印迹和串联质谱鉴定潜在的过敏原。通过挑战测试验证临床相关性。检测到对软木（云杉、松木和落叶松木材）、山毛榉木、天然橡胶乳胶（NRL）和辣根过氧化物酶（HRP）的特异性 IgE。在云杉木材中鉴定到作为过敏原的过氧化物酶，云杉木材是主要的过敏原来源。软木是最强的抑制剂。HRP 将 IgE 与软木的结合降低到<50%，表明主要是蛋白源表位，而 HRP 将 IgE 与 NRL 和山毛榉木的结合降低到>50%，表明主要是糖基化 IgE 表位。皮肤和挑战测试强调软木是致敏的来源。对于多敏患者，不仅通过挑战测试，而且还通过专门定制的体外工具，诊断出具有临床相关性的软木过敏。
