Occupational asthma and rhinitis caused by multiple herbal agents in a pharmacist

Abstract

Background: Herb agents have been widely used for centuries in the Orient and they have been cultivated throughout Asia. There have been a few cases of occupational allergy caused by herb materials. We report a case of occupational asthma and rhinitis caused by six herb materials in a pharmacist working at a pharmacy.

Objective: We sought the role of immediate hypersensitivity in herbal agent-induced asthma in a pharmacist.

Methods and results: The patient had strong positive responses on skin prick test to extracts of six herb materials: Chunkung (Cnidii rhizoma), Banha (Pinellia ternata), Sanyak (Dioscorea radix), Kangwhal (Ostericum koreanum), Danggui (Angelica radix), and Kunkang (Zingiberis rhizoma). Bronchoprovocation tests showed an early asthmatic response to Danggui extract. Serum specific IgE antibodies to Chunkung, Banha, and Sanyak were detected by ELISA with no specific IgE bindings to Kangwhal, Danggui, and Kunkang extracts. Twelve percent sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and IgE immunoblotting revealed one IgE binding component (60 kD) within Chunkung extract, two (10, 25 kD) in Banha, and four (33, 34, 65, 98 kD) in Sanyak. Basophil histamine release test revealed that Danggui extract could release a greater amount of histamine from basophils in the patient than in a healthy control.

Conclusions: Chunkung, Banha, and Sanyak may induce IgE-mediated bronchoconstriction in an exposed worker, and Danggui can cause bronchoconstriction by direct histamine-releasing effect from mast cells in a sensitized patient.