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Case Reports
. 2014 Mar 13:2014:bcr2014203861.
doi: 10.1136/bcr-2014-203861.

Holy Saturday asthma

Terence M O'Connor  1 , Ruth Cusack, Sarah Landers, Charles Patrick Bredin
Affiliations
Case Reports

Holy Saturday asthma

Terence M O'Connor et al. BMJ Case Rep. .

Abstract

A 61-year-old man complained of cough and dyspnoea after exposure to colophony-containing solder fumes at work. A histamine challenge test confirmed airway hyper-responsiveness, and colophony-challenge demonstrated a 16.7% drop in peak expiratory flow rate (PEFR), supporting a diagnosis of colophony-induced occupational asthma. At review, the patient presented with cough, dyspnoea and wheeze that occurred acutely when exposed to the fumes from burning incense during Easter Saturday services, necessitating his departure from the church. Inhalation challenge tests using two blends of incense used at his church (Greek and Vatican) led to identical symptoms and a significant reduction in forced expiratory volume in 1 s 15 min after exposure and PEFRs up to 48 h after exposure, indicating an early and late phase asthmatic reaction. This is the first report of coexistent colophony and incense-induced asthma. The similarities in chemical structures between abietic acid in colophony and boswellic acid in incense suggest a common mechanism.

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Figures

Figure 1
Figure 1
Peak expiratory flow rates (PEFR) measures after exposure to Greek and Vatican incense. Inhalation of Greek incense was associated with a 26% trough reduction in PEFR within 2 h (early allergen response) and a 16% trough reduction in PEFR, peaking at 19 h after exposure (late allergen response). Inhalation of Vatican incense was associated with a 19% trough reduction in PEFR within 2 h (early allergen response) and a 16% trough reduction in PEFR, peaking at 18 h after exposure (late allergen response).
Figure 2
Figure 2
Chemical structures of abietic acid, a component of colophony and β-boswellic acid, one of the main active components of incense.
See this image and copyright information in PMC

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