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Occupational and Environmental Lung Disease |

Inhalation Challenge With Bovine Dander Allergens*: Who Needs It?

Heikki Koskela; Antti Taivainen; Hannu Tukiainen; Hak-Kim Chan
Author and Funding Information

*From the Department of Respiratory Medicine (Drs. Koskela, Taivainen, and Tukiainen), Kuopio University Hospital, Kuopio, Finland; and the Department of Pharmacy (Dr. Chan), University of Sydney, Sydney, Australia.

Correspondence to: Heikki Koskela, MD, Department of Respiratory Medicine, Kuopio University Hospital, 70211 Kuopio, Finland; e-mail: heikki.koskela@kuh.fi



Chest. 2003;124(1):383-391. doi:10.1378/chest.124.1.383
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Published online

Study objectives: To identify which tests would be useful in selecting patients for a specific inhalation challenge with bovine dander allergens (bSIC).

Design: A prospective study.

Setting: A university hospital.

Patients: Thirty-seven dairy farmers with a clinical suspicion of occupational asthma due to bovine allergens.

Interventions: Each patient (n = 27) underwent histamine challenge, mannitol challenge, exhaled nitric oxide (NO) measurement, bovine-specific serum IgE measurement, and skin-prick test (SPT) with bovine allergens prior to undergoing a bSIC.

Results: Eleven patients responded to the inhalation challenge with bovine allergens. The sensitivity and specificity of the tests, based on this response, were 82% and 65%, respectively, for the histamine challenge; 20% and 94%, respectively, for the mannitol challenge; 27% and 77%, respectively, for the NO measurement; 82% and 100%, respectively, for the bovine-specific serum IgE measurement; and 100% and 50%, respectively, for the SPT. Multiple regression analysis revealed that only IgE-mediated sensitivity to bovine allergens, but neither bronchial hyperreactivity nor exhaled NO concentration, contributed significantly to the response.

Conclusion: Only the SPT with bovine allergens and bovine-specific serum IgE measurements were useful in selecting patients for the bSIC. This challenge should not be performed in SPT-negative subjects. A diagnosis of occupational asthma due to bovine dander allergens could be made without an inhalation challenge test in asthmatic patients with high bovine-specific serum IgE levels. This practice would eliminate the need for the majority of bSICs.

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