niiy, 1991, 46, r)

Specific IgE to reindeer epithelium in Finnishreindeer herders

K. RI-:IJULA', L. HAI.MI ' .PURO' , M . HANNI.IKSI:I .A\ E . LAKMI'^ ik ]. HASSI '

' ( ) i i l u K r u i o i i a l i i i s l i n i l r o f ( ) c < u p a t i o n a l I I I M I I I I . ( ) u h i . " i ) c [ ) a r ( i i i r n l n f I ) c n i i a l o l < ) t ; \ , ( ) u l i i I i i i \ c r s ] i \ " . a n d l i i s i i n i i c o l

( ) ( ( i i | ) a ( i n i i ; i l | - | c a l l l i , I I r l . s i i i k i , i M i i l a n t l

R c i i u l i T i - h f i d i i i L ; i s a m a j o r s o n i ' c r o f l i x i n t ; It if l u o i r i l i a n 11^00 i n l i . i h i i i i n i s i n

n o r l h c i n l ' ' t n l a i i ( l . T o t l c i n i n i n r t h e j > r r \ " a l c n i c o f i i l l r i i ^ i c s y m p t o m s a m o n i ; r r i i u l c i - r

h c i t l n s c l i i i u a l e x a m i n a l i o n s a n d . s k i n j ) r i f k [ c s i . s ( S I ' T ) w i i l i n i n e - i t i l i . i l a n i a l l c r m ' n s

w e r e p n i o i n u ' i l i n ' i l l r a n d o m l y s c l c i i o c l n i r n I r u m L'I l o fi!) ( n i r a i i •if)) \ r a r s . S p i - i i l i c

Ii^l' ' , a n l i h i K l i r s l o i * r i i i d c r r r | ) i l l i r i u i m ( R I ' ' ) a n d l o l a l s c r u m l t ; | - ' W T I T c - \ - a l n a ( i - d i n 1*9

h c r t U ' r s . f i \ ' c p e r s o n s w h o h a n d l e d r e i n d e e r U - a l l u T i n d t m r s , ' i 1 a i o p i c p a l i e n i s w i l h c o w

a l l e f t ; y a n d . n i o l h e i ' 2 0 s n b j c e i s w i l h s p i x i f l c I j ; ! ' ' , l o o i h e i ' I n h a h m i a l l e i ^ c t i s . P o s i i i v c

S P T l o K l ' ' , w a s d f t c c H c d i n o n e a n d s p t H i i ' i f l i ; l ' ' , 1) \ ' n s i n t ; e n z y m e ; i l l r i ' i ; o s o r l ) e m i f s l

( K A S T ) ( > ( ) . H I ' R L V n i i ) i n . s e \ r n h e i d e i ' s . S p e c i f i c l i ; !" , l o RV. w a s a l s o d c n i o n s i r a i e i l

i n o n e c o n l r o l . L ' s i n s ; R . \ S T i n l n h i l i o n a p a l i r n i w i l h c o w a l l c r i ; \ - d i t l n o t s l u > w

c r o s s - r e a e i i \ ' i i y h e i w e c n c o w a n d R l ' ' . w h i l e a n o i h e r p a i i e n i d i d . T h u s . I \ l ' ' , s h o u l d h e

i n i h i d e d i n d i e ; i l l e r i ; y l e s t p a n e l w l i e u h y p e i s e u . s i i i \ l i y l o R K i s s u s p e c t e d .

Kry i('(in/.\: a l h - r L j c n s ; a t o p y ; I,L;I ' ' . ; f e i n d e t - r e p i l h c - l i u m ; s k i n l e s t s .

Accff)/!'/! fdi Imhlualion 2<'i Frhiiuny /VV/

AlK-ri ic (lisorclors caused by animal proteins from worksliops producing- soiixcnirs of ivin-havo ivccntly bccouic one ol' (he major dis- deer leather in Lapland,eases in occupational medicine (;J, !). Rein-deei- herding is a common occupation inn<,,Uu.m Scandinavia. In Finland approx,-

^ ..^^ ^ ^ , ^ MKTHODSmalcly 7()()0 mnabilanls are engaged in herd-ing reiiulcer and lu'rding is ihe niani sonree ol . . .

(.liiitcal cxatiitnaUonliving lor more llian 4200 peo|:)le.

To eineidale the prevalence ol allergie ("linical e.xaininalion aeeoinpanied hy SPF.syniplonis among reindeer herder.s we e.xam- patch le.si and lung runelion te.sis were eon-ined 211 randomly selected men from northern ducted on 211 male renideer lierders randomlylMiiland. Clinical examination, SPT. patch selected from the following three lategoiies: 1)test, as well as lung funedon tesis were in- persons whose only work was reindeer herd-c-|uded in the study. In the present paijer we ing. 2) reindeer heiders who also worked a.steporl the results of speeific Igl'. to reindeer farmers, and 3) herders who also worked inepithelittm (Rl'^) in 99 reindeer herders, 21 offices. The mean working hcnn.s ol the her-atopics with specific lgl\ to cow e|)ithelinm ders were highest among the full-time herders(C;i'',), 20 patients with specific Igl' to other and lowest among those who also woiked ininhalant allergens, and five indoor workers offices. Their age varied IVom 21 lo ()!) (mean

.')78 K. Rl''. •A Al..

4.' ) years. In a<l(lilii)n, five persons, aged lioiii.'"id lo 62 (mean 4.''i.4) years, Ironi workslK)|3swhicli produce sotiveuirs of reindeer leather,were inclufled in llie clinical exaiiiinalion. I he(liniial data of ihe lest subjecls have been|)ieviovisly reported in delail ((), 8).

Skin prick lists

S P r was condnded on 211 herders and liveindoor workers. 'I'liey received neillier conven-tional antiliislaininie drugs lor '.'> days nf)r non-sedaling anlihislaiiiines lor 30 days belore ordtii'ing the test.

The nine SP'I' allergens were eal, cow, dogand horse epithelia, house dnst mite (D. pti-ronys-sintLs), birch pollen, meadow grass pollen antimugwort pollen (Allergologisk I ,aboratorinmA/S, ALK, Copenhagen, Denmark), al a con-eenlialion of 10 HI' P (hislamine ec|uivalenlpii(k) units and RM (]-'liaiina( ia, Uppsala, Sw(--t\vn) at a eoneenli alion ol 1:100 w/v.

TIK- Sl^'J' were a])|ilied on ihe inner forearm,and the results were read al'ler I-") min. Hisla-mine diliydro( liloride (10 mg/ml, ALK) was iheposilive control and TjO % gly<erol in water thenegative eonlrol. A reaction al leasl half the sizeof dial produced by hislamine was consideredposilive.

.SVra

Venous blood samples were: oblained al the timeof ihe elinie.al exaniinalion from all 211 herdersand llie fivt: mdoor workers. In addilion, sera olnine herdcns wilh positive SPT lo Cio werelesled, as well as sera ol live indoor workers and41 controls.

(Control sera were obtained Iroin patienisexamined al ihe Institute of OectipationalM(-alth, Helsinki, l''inland. 'I'wenly-one of ihe41 control palienis had chnical symploms, posi-tive SPJ' and spe(ili<: IgE conlirming CE al-lergy, and 20 patients had posilive IgE to alleasl one other inhalant allergen. No history ofex|)(isure lo Rl'', was present in eonlrol patients.'I'he sera of the lesI subjects and conlnil |)atients

were stored al -20°C and ihawed for use asneeded.

I'olal .serum Igli

The lolal sertim Igl'', was determiiu-d by usingcominei'cially available: Pliadc/.ym IgE-PRIST-lesl (Pharmacia Diagnostics, Sweden) accordinglo the mantilaclttrer's instrtu lions.

Specijic Igli to Rl'] and C/E

Specific IgE lo Rl''; and Cl''. was measured byusing an enzyme allergosorbenl lesl (EAST)(Pharmacia Diagiioslics) according lo the manu-fadurer's inslruclions. K\\ discs for RE, EASTwere prepared in Phainiacia laboralories Irom apiece ol newly slatightered, dry and tmwashedri'indeer leather provided by ihe present studygroup. The RE discs have since been commer-(ially available (Pharmacia Diagnostii s).

RAST'inhibilion lesl

RAST inhibition Icsls were perrormed as de-scribed earlier (9). Brielly, two serum sam]iles(I'll and Pl2) in whieh s]3eeiric Igl'', lo l^E andCl'', was deU:i:led by I'^ASJ' (score 3 m bolhsera), were lesled by using Rl' (Phatinaeia Di-agnoslics, Allergi'ii exiiaet ren, Rtinj^tjer 'Varan-dust, epilhel & dander, D811II1) and CE(AEK, Aguagen cow 1:100 w/v, 12)186,(Copenhagen, Denmark) as inhibiting allergens.PI I was from a reindeer herder wilh a posilivepii<k test to Rl*',, and Pr2 was from a controlwith cow allergy, who had never been exposedlo RE. In RAST inhiljition Rl' discs were used.

RESULTS

The results of elinical data, lung function tests,SPT and pateh lesls ol' 211 reindeer herdershave been deseribt:d elsewhere (6, 8). Brielly,using nine inhalanl allergens in SPT, 19 (9%)of 211 herders had positive reactions to at leastone allergen. A positive leaclion lo RE was

It;I'', TO R1'.IN1)1'',1'',R l'',pn'lll'',l,lUM .")79

delecled in one (0.5 A ) . Past or preseni atopic

derinalilis was diagnosed in :!() (17%) and aller-

gie rhinilis in 29 (1 I'/r ) reindeer herders. The

herder with a |)ositi\<' SP T to Rl'', was the only

one lo re|5oi't allergic-type symptoms I'roin

reindeers.

The resLills of mean total serum Igl'', and

s])e(ire Igl'^ lo Rl'', among 90 reindeer herders

appear in Table 1. Mean total Igl'', was 106.6

kU/iiil and was highesl (124.;) kU/ml) in her-

ders who also worked in offiees. ,'\niong iheni.

spixilii IgE ( > 0 . 8 P R U / m l ) lo Rl'', was also

the mosi eonmionly diieeled.

The results of the lol.il serum Igl'', and specific

Igl'', lo RE among reindeer herders, indoor

worki'i's e.x|)osed lo Rl',, and die eonlrols are

shown in I 'able 2. The highesl mean tolal Igl'',

(.')67.2 kU/ni l ) was delected in the palienis with

posilive IgE to Cl'',. Mean total Igl'^ was lowest

(16.2 kU/ml) among tlu' itidoor workers ex-

posed to RI'j.

Specific IgE lo Rl'", (> (1 .8 P R U / m l ) was

detecied in se\'en (8/( ) reindeer herders and in

Iwo ol nine herders wilh a |)osili\'e SP T to Cl',.

A posilive SP'I' was detec:ted in one herder who

also had a |)osili\'e S PT to C'l'',.

Results of the determination ofsiK-cific IgE to

(;l'', in those who had si)ecilie Igl'', lo Rl'', appear

in Table 3. In ihree of 10 subjecls wilh speeifie

lgl'> lo RE, the reaelion lo Cl'', was < 0.8

P R U / m l .

RAST inhibition was perforined by using two

sera (I'll and I't2) in both of whicli spc'cifie Igl'',

to Rl'', and Cl'', was detected in l'',AST (l''ig. 1).

When the first sertini ( I ' l l ) was inettbaled wilh

Rl'j, an inhibilion eould be demonstrated while

inetibation wilh CE did nol cause any signili-

caiil inhibilion. Wilh ihe other seittm (Pt2)

inhibition wilh Rl'', and Cl'', was roughly ec|tial.

Of 21 patients wilh cow ei)ithelitini allergy,

specifie Igl'j lo Rl'', was louiid m one wilh the

highesl total Igl'', (()400 kU/ml) and in another

with die highesl lexcl ol specific IgE lo ( 'E (16.0

P R U / m l ) . In ihe palienis wilh posil iw Igl'', to

other inhalant allergens a positive Igl'', lo Rl'',

was deteeted in one with high le\els of si^eeifie

Igl'', lo dog epithelitim (17..") PRLVml).

DISCUSSION

In the pie\ ions re|)orls ((). 8), we ha\H' deseribed

ihe resnlls of a clinical study among 211 rein-

deer herders. Aicording lo our findings, die

|)re\alence ol' allergie sym]Mc)ins and i)()siti\c-

SP 1' lo common inhalanl allergens was roughU'

ec|tii\'alent to die prevalenee found in the gen-

etal l''innish po|)nlalic)n. Howewr , die reacti\it>'

lo some allergens was e\en less lre(|uenl than

was expeeted ( I . 6). Only one herder had a

posilixc SP I to Rl',. In addilion. according to

the restills ol clinical examinations and patch

lc:sls with 31 allergens, oeetipational skill dis-

orders among reindeer herders were rare.

,-\c cording lo die pre\ ious lilerature. men have

a higher prewileiue of skin reaeli\'ily to eommon

inhalanl allergens than women (3). In addition,

the other iiiosi imporlant predielors ol skin tesl

reaelivily appear lo be age, urban residence and

poNc-rly status (:>). One ol'the major con I ribut ions

to the age-skin tesl relalionship is the total serttm

Igl'', lex'el whic h is ttstially highest in yotiiig people

and tends lo decrease with age ( I ) . .Skin lesl

ieaeli\ iiy is lower and sernm Igl'. levels are higlier

among smokers llian in non-smokers (2).

' l ' j h l r I

M e a n l o l a l f i ; ! ' . m u l s p i - i - i l i i - l i ; ! ' . m r r i i u l i - r r i - p i l l u - l i i i i i i [ R V . ] . c a n i l n c i u p a l i o n i n 9 0

Kri i id . - r r lu-idiiiK .mlv

1 l(-|-dcr a n d lai iiuT

ll(-i-dc-i. iilflu- woikc I

• V ; e ( \ T ) lnl-: k t ' / i n l

X ( . SD)

"Ifi.d ( I I(i7..'i)

'W.'l ( I '.!7'2.:i)

Rl'.-l'..\.sr > 0.;P R U / i i i l

' l 'olal Hit) I)

.580 K. ,A V:\' AL.

' l ' ( ) l ; i l I L ; I ' ' , i i n d s p c i ' l l i c It^i*- U) r e i n d e e r e ] ) i l l i e l i n ) i i ( K I ' " . ) i n i v i i K l c c i ' h e r d n s a n d t h e i r c o n l r o l s

Keindeer liefdecs

1 le rders wiih eow allergy

Iiidodi' workers widi Kl'. e\[)osui"e

Pat ients with ( ow al!ei'L;y

I 'al ienis with odiei ' alleit;ies

• ) l l

• I

.s21

20

4 7

• i ; i

:;7

.'if)

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.•1

.15

^1- (yr)

(rai,«

{22-(i(2;'.-(i(:io-(i(21-()

(2ll--'i

< • )

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i f ) )

•folal

\

101).()

'IO(i.O

l().2

-n i i .o

igi'.

( .

(-1-

( 1

( 1

(-1-

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k U / i i i l

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m,.'.y)7ll(i..''i)

').:',)

i:i.''if).-i)

7-11.7)

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> 0.

f'.

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7

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III

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10

N ' f

i\ f

NT ol I c s U - d , . S l * r .skill | ) r i (-k U-sl

111 the |)resenl study, all tesl sttbjects were

men. Ihe re are only a lew women m northern

l'inlantl whose m a m oecupalion is reindeer

herding. In accordance with previous studies,

we lotind ihal ihe mean tolal Igl'', varied in

dilTereiit occtipalion groups (3). T h e herders

who also worked in offices had a higher mean

lolal IgE than Inll-liine herders or reindeer her-

ders who also worked as farmers. I he dil lerenee

l)etwec:n the three grotips eould nol be c:.\plamed

by age, because die mean ages of full-time:

herders and those wlu) also worked in olltees

were' roughl) ' e-e|ual.

In aece)ielanee with prevteius sitidies, ihe

me-aii total Igl'', was also assoe i,itc:d wilh S P T

reaelivity in the prese:nl stuely ( I , f), 7). M e a n

le)lal serum IgE was alinosi 4-fe)lel higher anieing

he-relers wilh posilive S P T to Cl'', (406 U / m l )

llian a m o n g other herders (IO().() U / m l ) .

• f a b l e : : i

S | M - ( i l u - Is;!* ' . (i> i i i w ( - | i i l l i r l i i i i i i ( C l ' ' , ) i n l u - r d i - r s w i l l i s p r c i l i i -

l t ,d ' ' . ( > 0 . ( ! I ' K l I / i i i l ) I d r c ' i n d r r r r | > i l l i i - l i l l l l l ( R F . )

1 K 1 ' ' . l o CV

( I ' R t l / i i i l )

K.V.

I..K.

A.K.

K. K

JK.P R .K.S.

zr.

(\']<V

7.4.

-72.1.1.

0.

(I.

I R l '

/ml)

4

'I

'1HI

t)(!

a

2.7

I . I

( I . I

1.2

( I . I

().()

1.7

Speeifie Igl'', (> 0.8 PRU/ml) to Rl' eould bedelecled in seven (8%) of 90 herders and in Iwo

of nine herdc:rs with a positive: SP'I' lo Cl'j. Two

of lliem had a |)osilive SPT to Rl'',. The cause of

the diserepanc:y between SPT and l' AS'L results

cotild not be established. Llowever, the case

histories were positive: for reindeer allergy in

only one subjee t who had a |)ositive SP'f to Rl'^.

'l'lie specificity of positive I'',AST results to

Rl'', was tested with RAST inhibition by using

Iwo sera (I'll and Pl2) with speeifie IgE to Rl'',

and Cl''>. It shovild be noted thai I'll was from a

reindeer herder with a long period of ex|5osuri'

to R\i and a posilive priek test with Rl'.. Pt2, on

"Z.

o-nX

«

100

80

60

40

20

n

_ o•

D

•

-

P'1,Pt1,Pt2,Pt2,

reindeer extractcow extract ^ — ^ " ^ ^reindeer extract ^^,,,-'-^ ^^...^^

cow extract f^ ^...-""''j'

[// / /// y/ / /

/

1:625 1:125 1:25 1:5 1:1

DILUTION OF INHIBITOR EXTRACT

I ' i i ^ . I . R A S ' I ' i i i l i i h i l i o n w ; i s | H - i - i ( i i i n < - d l ) \ ' n s i i i . n t w o s e r ; i

( I ' l l n t i d l ' l ! ^ , s e e ( e . \ ( ) w l i i e l i w e r e i n e n l ) i i ( c < l w i l h d i l l e r e n i

d i l i i l i o n s o l ' 111 ' ' , i t i x l iW,. I ' l l i s I V o n i ;i r e i n d e e i - l i e r d e i " j u i d

1*1'-^ I t o n i a n i i ( ( ) | ) ; e | ) ; i l l e i i l w i t h e o w i i l l c i " L ; y .

!'', 'l 'O Rl'',INni'',l'',R KPl ' l ' l lKLIl 'M .')81

die e)lher hand , was l're)m an alopie' |)atie'nl wilh

(e)w allergy aiiel wlie) had never been exposed te)

Rl',. Afier ineubatiein of Pt l with Cl'',, no re-

markable inliibilie)n e'e)uld be eleteele'el in R A S 1

inhibitie)n while- incnbatiejn with Rl'', she)wed a

ele-ar inhibition e)f 93'/{). The- present finding

she)ws that by tisiiig I'll we e'e)ulel eleme)nstrate

the- i)resenee e)f an tmie|ue allergen (alle-rgens) in

Rl'', whieh de)e-s ne)t appear in C l'',. T h e R A S T

inhibilion results with the other se-rtmi (Pt2)

slie)\v that the pe)siti\'e- RE-EAS' l ' oblained with

the e'e)ntrol serum was due to eommon allergens

in Rl': and Cl'^.

Ae-eording to die present s indy. the highest

l)re-valenee of pe)siti\-e- IgE to Rl', was le>uncl m

lierelers whe) alse) worked in e)tfiex-s. l'hey alse)

hael the- highest mean te)tal Igl'',. In e)ui' |)revious

sittelie-s we fe)tmel that there we-t-e ne) statistieal

elilTere-nees in siiie)king habits be-tweeti the- difl'er-

c-nt grotips of he-rders (8). T h u s , sine)kiiig eoulel

not c-x|)lain the diffe-renee either in iiie-an IgE e)r

in |)osilive Igl'', lo R l v

A m o n g the iiide)e)i' we)rkers e-xpe)se-el to Rl'^

one- e)f five hael a pe)silive Igl', te) Rl'',. Ne^ne e)l

them had a jiositive- S P T te) Rl'',. Se)tivenirs

inaele of reinde'c-r Ic-athe-r a ie ttsttally prexluceel

in small workslu)|)s with few em])le)yee-s. l'',xpo-

sure- lo R E diisl in the- we)rkshoi)s is heav\-

be-eattse e)l'the iiie-ffieient ventilatie)n in lliese olel

bttilelings. Eurtlu-r sitidies are- in pie)gi-ess te)

e-stablish the anie)ttiil e)l' R E and e)tlie-r allergens

in the- air of llic-sc- worksho]3s.

A sjieeifie Igl'', to Rl'', was deteeti-el in one

sttbje-e't with elefmile- alle-rgy te) ce)mme)n inhalanl

allcrge'iis other than e-e)W and withe)tit c-X]M)sure

le) Rl'',. T h e liigli te)lal serum Igl'', mighl e-xplain

the result.

In e-e)nclusie)n, speeifie- IgE te) RE was mea-

sureel in Einnish re-inde-er herele-rs. ale)pie pa-

lie-nls anel subje-cls e-xposed to Rl',. Iligli le\'els

e)r Rl'',-siJecifie- Igl'', antiboelies we-re- eleteeted

nH)re- e)flen aine)ng par t - l ime re-inelee-r herders

than I'till-time lierelers suggesting that he-avy ex-

pe)sure- te) RI'^ may eatise tolerance- ralhe-r than

hype-rse-nsitivity. Ihe- speeilieity lest by R,'\S'l

inhibilion demonstrate-el that Rl'', lias e-e)minon

antigens with ("1'', but alse) s])ee'ies siJe-eifie anti-

ge-ns. We sugge-sl ihat llu: mcasttrenu'ii t e)f spe-

eifie- Igl'', to Rl'', shotild be inelttde-el in the test

|3ane-l e)l pat ienls with suspecteel liype-rsensitivity

lo reindeer.

W'e wish to d i ank Dr . Joi-daii I ' ink, M . H . . lor his interest in

(he s tudy . Sirp;i P ikka r ; imen , M . I V . Mer j a Kan l ; i -Suon ie l a ,

I'',e\';i-1 .lisa K o k k o n e n a n d S i rkka I lirii ai'e kiiuIK' t l ianked

loi' (heir tcc^hnieal assist a nee. T h e j iersonnel ot '2!! loeal

h e a h h ea i e cen te r s and the nieni lx ' rs of (lie reindi-ei" h e r d e r

assor ia t ions in n o r d i e n i iMiiland are i;raielnl!\- acknowl-

edged . T h e stud\- has heen l 'mani ia lh ' su]) |)orted h\- tin-

I'"aiiner's Social l n s n i a i u e Institiititin ami the I 'oniu ia i ion ttir

the S tnd \ ' (>!• Al lergy. Hels ink i , I ' in land .

1. Harhee R A . Hrowii W C . K a l t e n h o r n W . l l a l n n e n M .

Al lergen skin-test i-eac(i\'it\' in eoininuni t \ - |)O])u!at!on

s a m p l e : cor re la t ion w\\]i a_i;f. h i s t a m i n e skm reai-tu>Hs.

and tolal s e r n m iminnnoi^ lohul in V.. ] Alleri^y ( ' t in Im-

n u m o l fn'l. lT.-l!). IDHI.

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A d t h r s s

Dr. Kan Rnjuh. M . l ) . .

C )uhi Regional Insti(nte of C )ec npat ional I lealdi

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